Accidental Drug Research Articles

Cardiovascular Disease in Acute Cocaine Compared to Acute Fentanyl Intoxication Deaths.

Cocaine is the most common stimulant drug that causes death in Connecticut. Unlike opioid intoxication deaths, which largely correlate with dose/concentration, cocaine deaths occur more idiosyncratically, with mechanisms of death often related to underlying cardiovascular disease. We examined 78 sole acute cocaine and 306 sole acute fentanyl intoxication deaths to assess their association with cardiovascular disease. In the cocaine cohort, 87% (68/78) had atherosclerotic and/or hypertensive cardiovascular disease while 40% (122/306) in the fentanyl cohort did. Cocaine was detected in 40% of all accidental drug intoxication deaths, 41% of all accidental drug intoxication deaths involving fentanyl, and 37% of all drug intoxication deaths involving heroin. The relatively low number of sole cocaine deaths compared to the much higher proportion of cocaine/opioid deaths may be explained by the synergistic effects encountered in many mixed drug intoxications, the contributory role of cardiovascular disease in sole cocaine deaths, and/or the increased prevalence and potency of fentanyl. The high number of sole cocaine deaths in which the decedents had co-existing heart disease compared to those from sole fentanyl deaths (P < 0.001) suggests that heart disease plays a mechanistic role in sole cocaine deaths, whereas the potency of fentanyl is the dominant mechanism in fentanyl deaths.

Medication stewardship in the operating theatre in Malaysia: A quality improvement project.

A quality improvement project ('Safe Anaesthesia for ALL-SEAL') was implemented to reduce preventable medication errors and drug wastage in the operating theatre (OT) of a tertiary hospital. The primary objective of this quality improvement project was to prevent the incidence of medication errors, and the secondary objective was to reduce the wastage of unused drugs. A pre-intervention questionnaire and an audit survey were performed, and multidirectional interventions were designed post-survey. A post-intervention survey was conducted to evaluate effectiveness. The incidence of medication errors, including near misses, was assessed for root causes. Unused drugs drawn or diluted in syringes were recorded daily in each OT. The weekly drug orders and mid-week reordering frequency were also monitored. The data were reported as simple means and percentages. Ninety-eight anaesthesia care providers participated in the survey (72.4% doctors and 27.6% anaesthetic nurses). Pre-intervention, 76.1% of respondents had experienced medication errors during their practice. Common errors included misidentification of ampoules or vials (65.2%), miscalculation of dosages (65.2%), improper syringe labelling (56.5%), accidental drug omission (54.3%) and wrong prescriptions (39.1%). The main sources of errors were fatigue/overwork (80.4%) and a hectic OT environment (71.7%). Post-intervention, no incidents of medication errors were reported. In addition, there was a significant reduction in drug wastage. The SEAL project positively prevented medication errors and reduced drug wastage, which should be further validated in other clinical settings.

Cause-specific mortality in treatment-resistant major depression: Population-based cohort study

BackgroundLimited evidence-base on long-term prognosis of treatment-resistant major depression (TRD) is a barrier to clinical decision-making. Therefore, the purpose of this study was to establish cause-specific mortality in TRD compared to non-TRD major depression. MethodWe identified all individuals with a diagnosis of major depression (MDD) who were treated with an antidepressant aged 15 to 65 years during 2004–2016 in Finland. Persons with over two treatment trials were defined to have TRD. Data were analysed with Cox proportional hazard models. Results176,942 individuals with MDD (63 % women, median age at index diagnosis 40 years), of whom 11 % (n = 19,305) fulfilled the TRD criteria, were followed-up for 1,525,646 person-years (median 8.9 years). There were 959 deaths (6.1 deaths/1000 person-years) in TRD and 7662 deaths (5.6/1000 person-years) in non-TRD. All-cause mortality was 17 % higher (adjusted hazard ratio (aHR), 1.17; 95 % confidence interval (CI), 1.09–1.25) in TRD compared to non-TRD, when sex and age at index antidepressant prescription were controlled for. In TRD, increased mortality was observed for suicides (aHR, 1.90; 95%CI, 1.64–2.20) and for accidental poisonings (aHR, 1.81; 95%CI, 1.48–2.22), but not for natural causes (aHR, 0.98; 95%CI, 0.90–1.07). A higher proportion of accidental drug overdoses was observed in TRD than in non-TRD (62 % vs 42 %, respectively). LimitationsDefinition of TRD lacks consensus. We used routine data to define TRD. ConclusionsThe markedly increased mortality due to suicides and accidental overdoses suggests that persons with TRD may experience higher intensity symptoms and more severe suicidal ideation than persons with non-TRD major depression.

Pharmacokinetics of isavuconazonium sulfate and its active metabolite isavuconazole in healthy dogs.

Invasive fungal infections (IFIs) are growing in importance in veterinary and human medicine. IFIs such as aspergillosis, blastomycosis, coccidioidomycosis and histoplasmosis remain challenging to treat in dogs. Isavuconazole is a novel antifungal medication that, when compared to currently used azoles, has an expanded spectrum of antifungal activity Rudramurthy (2011), Pfaller (2013), Spec (2018), has more predictable pharmacokinetics in humans Desai (2016), Cojutti (2021) and may cause fewer side effects such as liver and renal toxicity Maertens (2016), DiPippo (2018). The pharmacokinetic profile and safety of isavuconazole in dogs has not yet been characterized. The purpose of this study was to evaluate the pharmacokinetics of isavuconazole in healthy dogs that received a single dose of the prodrug isavuconazonium sulfate. Using full crossover design, six healthy beagle dogs received isavuconazonium sulfate at a mean (+/- SD) dose of 20.6 (+/- 2.8) mg/kg orally and 21.8 (+/- 4.2) mg/kg intravenously. Plasma was collected for batched pharmacokinetic analysis of prodrug and metabolite, isavuconazole, by ultra-high-pressure liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). The median (Q1-Q3) maximum isavuconazole peak plasma concentration was estimated at 3,876.5 (2,811.0-4,800.0) ng/mL following oral administration, with a median (Q1-Q3) peak level at 1.3 (1.0-2.0) hours. Following intravenous administration, the median (Q1-Q3) isavuconazole peak plasma concentration was estimated at 3,221.5 (2,241.5-3,609.0) ng/mL, with a median (Q1-Q3) peak level at 0.4 (0.3-0.6) hours. The median (Q1-Q3) half-life of isavuconazole was 9.4 (7.0-12.2) hours and 14.0 (8.1-21.7) hours for oral and intravenous routes, respectively. One dog received inadvertent subcutaneous drug administration without any apparent adverse effects. Another dog experienced an anaphylactic reaction following accidental rapid drug infusion. No other drug-related adverse events were observed. At dosages used in this study, healthy dogs achieved isavuconazole plasma levels comparable to human therapeutic targets, and when properly administered the drug was well-tolerated.

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

To examine the effects of revision of Australian mortality statistics every year since 2007 on numbers and rates of suicide and 'hidden suicide'. 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. 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. 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.

Higher Rates Of Homelessness Are Associated With Increases In Mortality From Accidental Drug And Alcohol Poisonings.

Alcohol and drug overdoses have multiple complex causes. In this article we contribute to the literature that links homelessness, the most extreme form of housing disruption, to accidental SUD-related poisonings. Using plausibly exogenous variation from a state's landlord-tenant policies that influence evictions, we estimated the causal impact of homelessness on SUD-related mortality. We found large effects of homelessness on SUD-related poisonings (for example, a 10percent increase in homelessness led to a 3.2percent increase in opioid poisonings in metropolitan areas). Our findings indicate that reducing local homelessness rates from the seventy-fifth to the fiftieth percentile levels could have saved more than 1,900 lives from opioid overdoses across all metropolitan localities in the final year of our study data. We conclude that strengthening the social safety net in terms of housing security could help curb the ongoing SUD-related poisoning epidemic in the US.

MATT-DDI: Predicting multi-type drug-drug interactions via heterogeneous attention mechanisms

The joint use of multiple drugs can result in adverse drug-drug interactions (DDIs) and side effects that harm the body. Accurate identification of DDIs is crucial for avoiding accidental drug side effects and understanding potential mechanisms underlying DDIs. Several computational methods have been proposed for multi-type DDI prediction, but most rely on the similarity profiles of drugs as the drug feature vectors, which may result in information leakage and overoptimistic performance when predicting interactions between new drugs. To address this issue, we propose a novel method, MATT-DDI, for predicting multi-type DDIs based on the original feature vectors of drugs and multiple attention mechanisms. MATT-DDI consists of three main modules: the top k most similar drug pair selection module, heterogeneous attention mechanism module and multi‑type DDI prediction module. Firstly, based on the feature vector of the input drug pair (IDP), k drug pairs that are most similar to the input drug pair from the training dataset are selected according to cosine similarity between drug pairs. Then, the vectors of k selected drug pairs are averaged to obtain a new drug pair (NDP). Next, IDP and NDP are fed into heterogeneous attention modules, including scaled dot product attention and bilinear attention, to extract latent feature vectors. Finally, these latent feature vectors are taken as input of the classification module to predict DDI types. We evaluated MATT-DDI on three different tasks. The experimental results show that MATT-DDI provides better or comparable performance compared to several state-of-the-art methods, and its feasibility is supported by case studies. MATT-DDI is a robust model for predicting multi-type DDIs with excellent performance and no information leakage.

The impact of the COVID-19 pandemic on accidental and suicidal drug intake rates, what has the pandemic changed?

The primary aim of this study was to review the patients admitted to pediatric emergency service with a history of accidental and suicidal drug intake within the first nine months of the pandemic period and the same period a year ago. The study is done retrospectively on patients with a history of accidental and suicidal drug intakes between March-December 2019 and March-December 2020. The study included 360 patients. Of 250 (69.4%) patients admitted in 2019, 163 (65.2%) of them were accidental drug intakes, while 87 (34.8%) were suicidal drug intakes. In 2020, of the 110 (30.6%) patients admitted, 73 (66.4%) of them were accidental drug intakes, while 37 (33.6%) were suicidal drug intakes. The ratio of accidental drug intakes to total patient admissions in 2019 and 2020 was 0.23% and 0.33%, respectively (z=-0.44; p=0.65). The ratio of suicidal drug intakes to total patient admissions in 2019 and 2020 was 0.12% and 0.16%, respectively (z=-0.1956; p=0.84), and an increase in the ratio of suicidal drug intakes was observed during the pandemic. With the pandemic, increased cases of neglect because of accidental drug intake and the increase in suicidal drug intake are worrisome. Protecting and improving the mental health of the society, especially of parents and adolescents, is very important in preventing suicide and child neglect and abuse from reaching dangerous levels in pandemics.

Acute drug intoxication in childhood: a 10-year retrospective observational single-centre study and case reports.

Medication poisoning in children is a severe condition that can endanger a child's life. Although drug intoxications are easily preventable, awareness of the proper handling of drugs and their safe storage out of the reach of children is not widespread among the general public. In this work, we investigated the demographic and clinical data of children admitted to the Department of Pediatrics of the University Hospital Olomouc for acute drug-induced intoxication. We also selected several case reports to illustrate the wide range of both presentations and outcomes in individual patients. Cases of drug-induced intoxications were selected from a group of patients under the age of 19 years admitted to the hospital for poisoning between January 1, 2010, and December 31, 2019. Medical records of these patients were prospectively evaluated, and overview tables and graphs of predefined research objectives were created. During the given time period, 162 children with suspected drug intoxications were hospitalized at the Department of Pediatrics, University Hospital Olomouc. Of these, 108 cases were reported in girls and 54 in boys (66.7% vs. 33.3%). In 16 cases (9.9%), there was a severe intoxication requiring follow-up intensive care. There was also one case of fatal accidental intoxication. Most poisonings were seen in toddlers (65; 40.1%). Intoxication with suicidal ideation was found in 44 cases (27.2%), with a higher incidence of suicide attempts in girls (40 vs. 4). Repeated intoxication was recorded in nine cases. Analgesics were the most common drug group (61; 37.7%), with paracetamol (28; 17.3%) being the leading drug. In 154 cases (95.1%), the drugs were taken orally, most often in the form of tablets. Accidental drug intoxications most frequently occurred in the age group from one to three years old. The second highest incidence was among adolescents most of which were suicide attempts. Analgesics and psychoactive agents accounted for the majority of cases. Medications should be kept in places where children cannot reach them.

Evolving trends in drug overdose mortality in the USA from 2000 to 2020: an age-period-cohort analysis.

Drug overdose deaths in the USA have increased rapidly in the past 20 years, and understanding patterns and trends in mortality is essential to develop policy responses. This study aimed to determine whether cohort patterns in mortality due to drug overdose have changed in the past two decades and assess these patterns by race and sex. The national records of accidental drug overdose death were extracted from Centers for Disease Control and Prevention, National Center for Health Statistics Mortality Data for 2000-2020. Age-period-cohort analysis was performed to examine independent effects of age, period and birth cohort on accidental drug overdose mortality. The number of accidental drug overdose deaths increased by 622% between 2000 and 2020, and age-standardized mortality rates increased nearly four-fold in both men and women. Age-period-cohort decomposition found rapid increases in mortality since 2012 in men and women, with higher mortality risk in cohorts born after 1990. The fastest increase occurred in Black Americans since 2012, and Americans of all races born after 1975 had significantly higher mortality risk, with mortality risk increasing rapidly in more recent cohorts. The peak of mortality has shifted from the 40-59 age group to the 30-40 year age group in the past decade. The burden of drug overdose mortality has shifted to younger Americans, and a new generation of Americans are at significantly higher and rapidly increasing risk of overdose death. Urgent action is needed to prevent an entire generation of young people being consigned to decades of preventable mortality. None.

Cost analysis of poisoning cases admitted to the emergency department

Aims: Poisoning incidents are frequently encountered and can often result in fatal outcomes in emergency departments. This study aimed to examine the demographic characteristics of patients diagnosed with drug poisoning in the emergency department and to analyze the associated healthcare costs. Methods: The study retrospectively analyzed patients admitted to the Nevşehir State Hospital emergency service between January 1, 2017, and December 31, 2018, due to both accidental and intentional drug poisoning. The number of patients diagnosed with drug poisoning in the emergency department was assessed by month and year. Aspects such as the demographic characteristics of the patients, the times of their admission to the emergency department, the outcomes in the emergency department, and the associated costs were compared. Results: The emergency department received a total of 520,672 patients. Among these, 659 patients who were diagnosed with drug poisoning and had complete data were included in the study. Women constituted 65% of the study population. The patients were categorized into two groups: children under the age of 18 and adults aged 18 and over. The average age of the pediatric patients was 7.7, while the mean age of the adult patients was 30.2. When the emergency service costs were compared with the age and gender variables of the admissions, no statistically significant difference was observed (p&gt;0.05). However, a statistically significant difference was noted in terms of cost when the times of admission for patients in the emergency department were compared (p&lt;0.05). Conclusion: Given the morbidity and mortality rates associated with poisoning, the financial burden it imposes is substantial. It is necessary to develop targeted preventive health services to reduce the incidence of poisoning cases.

Using Natural Language Processing to Predict Fatal Drug Overdose From Autopsy Narrative Text: Algorithm Development and Validation Study.

Fatal drug overdose surveillance informs prevention but is often delayed because of autopsy report processing and death certificate coding. Autopsy reports contain narrative text describing scene evidence and medical history (similar to preliminary death scene investigation reports) and may serve as early data sources for identifying fatal drug overdoses. To facilitate timely fatal overdose reporting, natural language processing was applied to narrative texts from autopsies. This study aimed to develop a natural language processing-based model that predicts the likelihood that an autopsy report narrative describes an accidental or undetermined fatal drug overdose. Autopsy reports of all manners of death (2019-2021) were obtained from the Tennessee Office of the State Chief Medical Examiner. The text was extracted from autopsy reports (PDFs) using optical character recognition. Three common narrative text sections were identified, concatenated, and preprocessed (bag-of-words) using term frequency-inverse document frequency scoring. Logistic regression, support vector machine (SVM), random forest, and gradient boosted tree classifiers were developed and validated. Models were trained and calibrated using autopsies from 2019 to 2020 and tested using those from 2021. Model discrimination was evaluated using the area under the receiver operating characteristic, precision, recall, F1-score, and F2-score (prioritizes recall over precision). Calibration was performed using logistic regression (Platt scaling) and evaluated using the Spiegelhalter z test. Shapley additive explanations values were generated for models compatible with this method. In a post hoc subgroup analysis of the random forest classifier, model discrimination was evaluated by forensic center, race, age, sex, and education level. A total of 17,342 autopsies (n=5934, 34.22% cases) were used for model development and validation. The training set included 10,215 autopsies (n=3342, 32.72% cases), the calibration set included 538 autopsies (n=183, 34.01% cases), and the test set included 6589 autopsies (n=2409, 36.56% cases). The vocabulary set contained 4002 terms. All models showed excellent performance (area under the receiver operating characteristic ≥0.95, precision ≥0.94, recall ≥0.92, F1-score ≥0.94, and F2-score ≥0.92). The SVM and random forest classifiers achieved the highest F2-scores (0.948 and 0.947, respectively). The logistic regression and random forest were calibrated (P=.95 and P=.85, respectively), whereas the SVM and gradient boosted tree classifiers were miscalibrated (P=.03 and P<.001, respectively). "Fentanyl" and "accident" had the highest Shapley additive explanations values. Post hoc subgroup analyses revealed lower F2-scores for autopsies from forensic centers D and E. Lower F2-score were observed for the American Indian, Asian, ≤14 years, and ≥65 years subgroups, but larger sample sizes are needed to validate these findings. The random forest classifier may be suitable for identifying potential accidental and undetermined fatal overdose autopsies. Further validation studies should be conducted to ensure early detection of accidental and undetermined fatal drug overdoses across all subgroups.

Prior Emergency Medical Services Utilization Among People Who Had an Accidental Opioid-Involved Fatal Drug Overdose-Rhode Island, 2018-2020.

To help understand whether decreased emergency medical services (EMS) utilization due to the COVID-19 pandemic contributed to increased accidental fatal drug overdoses, we characterized recent EMS utilization history among people who had an accidental opioid-involved fatal drug overdose in Rhode Island. We identified accidental opioid-involved fatal drug overdoses among Rhode Island residents that occurred from January 1, 2018, through December 31, 2020. We linked decedents by name and date of birth to the Rhode Island EMS Information System to obtain EMS utilization history. Among 763 people who had an accidental opioid-involved fatal overdose, 51% had any EMS run and 16% had any opioid overdose-related EMS run in the 2 years before death. Non-Hispanic White decedents were significantly more likely than decedents of other races and ethnicities to have any EMS run (P < .001) and any opioid overdose-related EMS run (P = .05) in the 2 years before death. Despite a 31% increase in fatal overdoses from 2019 through 2020, corresponding with the onset of the COVID-19 pandemic, EMS utilization in the prior 2 years, prior 180 days, or prior 90 days did not vary by time frame of death. In Rhode Island, decreased EMS utilization because of the COVID-19 pandemic was not a driving force behind the increase in overdose fatalities observed in 2020. However, with half of people who had an accidental opioid-involved fatal drug overdose having an EMS run in the 2 years before death, emergency care is a potential opportunity to link people to health care and social services.

743 - Retrospective review of accidental toddler drug ingestion; the clinical manifestations and length of stay.

743 - Retrospective review of accidental toddler drug ingestion; the clinical manifestations and length of stay.

Late Presentation of Acute Limb Ischemia: Causes and Outcomes.

To determine the causes of interventions in patients with acute limb ischemia (ALI), the time lapse of presentation, and the outcome. An observational study. All delayed acute limb ischemia cases (presenting later than 6 hours after the onset of symptoms) were included in the study. Cases of ALI secondary to accidental trauma were excluded except those of iatrogenic trauma like patients with intravenous drug abuse and intra-arterial accidental drug infiltration. Patients' demographic data, clinical history, aetiology, examination findings, and treatment data; including type of surgery, level of amputation, adjunctive treatment were recorded. Total number of delayed ALI cases was 147. Mean age was 59.52 ±17.77 years. Seventy-five (51%) were females while 72(49%) were males. The right lower limb was involved in 56(38%) cases. A hundred (68%) thromboembolectomies were successful and limbs were saved, while 19(12.9%) had failure after the procedure. Three (2%) patients expired within 24 hours of thromboembolectomy. Twenty-five (17%) had frank gangrene at presentation and ended up in amputations while 122 (82.9%) had questionable viability and underwent limb salvage procedures. Delayed presentation of ALI is very common; timely management with effective thromboembolectomies can save limbs in most of the patients. Acute limb ischemia (ALI), Treatment, Amputation, Thromboembolectomy, embolism.

Controlled Substance Prescription History among Individuals Who Died of an Accidental Opioid-Involved Drug Overdose in Rhode Island

Background: Accidental opioid-involved overdose deaths are increasing nationally in the wake of the COVID-19 pandemic, but it is unclear if this reflects a change in populations most at risk. Objective: To determine whether the demographic characteristics and controlled substance prescription history of accidental opioid-involved drug overdose decedents in 2020 differed from prior years. Methods: We identified accidental opioid-involved overdose decedents using Rhode Island (RI) State Medical Examiner’s Office data. Decedents were linked to the RI Prescription Drug Monitoring Program database. We compared demographic characteristics and prescription history by year of death. Results: From 2018 to 2020, 763 RI residents died from accidental opioid-involved overdose in RI. From 2018 to 2019, deaths decreased by 7%, but then increased by 31% from 2019 to 2020. Demographic characteristics were similar by year of death (all p > 0.05). The percentage of decedents with a prior opioid prescription and a prior benzodiazepine prescription declined from 2018 to 2020 (p < 0.01 and p = 0.03). Conclusions: We found that opioid-involved overdose deaths in RI are increasing overall, but without significant changes in demographics. While prior exposure to some controlled substances did decline over time, it is not clear if these changes reflect more responsible prescribing practices, or a more concerning pattern such as patient abandonment or decreased healthcare access. More studies are needed to better describe the current trend of increasing opioid-involved deaths while also pursuing current evidence-based interventions.

Insulin and Oral Hypoglycemic Drug Overdose in Post-Mortem Investigations: A Literature Review.

Background and Objectives: Insulin and oral hypoglycemic agents are drugs widely used in the world population due to their therapeutic effects on diabetes mellitus. Despite these benefits, they can also cause accidental or voluntary drug overdose. This review aims to evaluate post-mortem investigations in cases of suspected hypoglycemic drug overdose. Materials and Methods: We performed a comprehensive search using the Preferred Reporting Items for Systematic Review (PRISMA) standards; we systematically searched the PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EM-BASE) databases from the point of database inception until August 2022. The following inclusion criteria were used: (1) original research articles, (2) reviews and mini-reviews, (3) case reports/series, (4) and only papers written in English. Results: Thirty-three scientific papers, including original research articles, case reports, and case series, fulfilled the inclusion criteria. A total of 109 cases of insulin or hypoglycemic drug overdose were found. There were 71 cases of suicide (65%), 25 cases of accidental poisoning (23%), and 13 cases of homicide (12%). The most commonly used drug was insulin (95.4%). Autopsy and post-mortem examinations were performed in 84 cases, while toxicological investigations were performed in 79 cases. The most common gross findings in the autopsy were pulmonary edema (55.7%) and congestion (41.8%), while the most common histological finding was neuronal depletion or necrosis (29.1%). Conclusions: In the suspicion of death from insulin or overdose from oral hypoglycemic agents, autopsy findings may be nonspecific, and the search for injection marks can be positive at the external examination. Significant post-mortal alterations can interest biological samples and an early autopsy investigation is recommended.

Unintentional subarachnoid administration of tranexamic acid during spinal anesthesia

An accidental intrathecal tranexamic acid injection is a rare but extremely unpleasant case, which can lead to severe complications, including death. This review aimed to describe the clinical, pathophysiological changes and outcomes occurring in patients with unintentional tranexamic acid subarachnoid injection during spinal anesthesia. The review includes studies published in PubMed, The Cochrane Library, Google Scholar, and the Russian Science Citation Index databases. There were 31 reports (27 literature reports and 4 own observations) of unintended tranexamic acid administration during spinal anesthesia, including 12 cases in traumatology and orthopedics, 11 cases in cesarean section, and 8 cases in urology and general surgery. Typical signs and symptoms reported by the authors include severe pain in the lower back, buttocks, and lower extremities, seizure syndrome, marked tachycardia and arterial hypertension, and ventricular arrhythmias. Ten (32.1%) patients recovered without any consequences and six (19.4%) patients required long-term rehabilitation after hospital discharge due to severe neurological deficits or cognitive impairment. Of 11 females, 9 died during cesarean section and 4 of 12 patients died in traumatology and orthopedics. Overall, 15 (48.4%) patients had a fatal outcome. An unintentional subarachnoid tranexamic acid injection is a catastrophic event with extremely high patient risk and is accompanied by high mortality, especially in obstetric practice. Intensive care should include intravenous propofol or sevoflurane inhalation in the case of unintentional intrathecal tranexamic acid injection, and cerebrospinal fluid lavage is promising. Developing a formalized protocol for intrathecal administration of local anesthetic solutions is advisable to avoid errors associated with accidental drug administration not intended for spinal anesthesia.

A Study was Under taken to Assess the Effectiveness of Structured Teaching Program on Knowledge Regarding Various Methods to Check the Placement of Nasogastric Tube in Patients among Student Nurses

The normal healthy adult can consumes food orally. Patients who are unconscious, surgery on throat, paralysis of soft palate, requires nasogastric tube feeding. In hospitals, nutrition may refer to the food requirements of patients, including nutritional solutions delivered via an IV (intravenous) or fluid food delivered by Nasogastric tube. It refers to the process of placing a soft plastic Nasogastric through a patient’s nostril, past the pharynx down the esophagus in to the patient stomach. The most common indication for inserting a Nasogastric tube is to deliver tube feeding to patients when they are unable to eat especially, Patient who have undergone neck or facial surgery or patient on mechanical ventilation. It is used to empty the stomach when accidental poisoning or drug overdose has occurred, and it is also used to remove air that accumulate in the stomach during cardio pulmonary Resuscitation. It is used to remove the stomach content after major trauma or surgery to prevent aspiration of the stomach content. Placing Nasogastric tube helps to prevent Nausea and vomiting by removing stomach contents and preventing distension of the stomach other a patient has a bleeding ulcer, bowel obstruction, or other gastrointestinal disease. It helps to be inserted to take samples of stomach contents for laboratory studies and to test for pressure of the gastrointestinal tract. Materials and Methods: A quasi-experimental single group pre-test post-test design to evaluate the effectiveness of structured teaching program on knowledge regarding various methods to check the placement of nasogastric tube in patients. The study conducted on 50student nurses. Data was collected in the month of August - September 2022. Data was collected using structured questionnaire to evaluate the effectiveness of structured teaching program on knowledge regarding various methods to check the placement of nasogastric tube in patients. Results: The data revealed that, the significant level stated as P&lt;0.05. Overall pre-test mean score was 16.92. The overall post-test mean score was 26.32. The comparison was analyzed by using paired ‘t’ test and value was 23.20. This was found statistically significant at &lt; 0.05 level of degree of freedom. Then final findings were associated with demographic variable in educational status was significant and other demographical variable such as age, gender, current residence, previous source of information was not significant. Conclusion: After the detailed analysis of the study it shows that structured teaching program on knowledge regarding various methods to check the placement of nasogastric tube is effective in enhancing knowledge about same among student nurses. A relationship between the students and the teachers helps to empower the knowledge in the students to deal adequately with the patients with nutritional needs.

Toxicology in the emergency department: what's new?

Intentional and accidental drug overdose, recreational drug use and exposure to toxic substances are common reasons for people presenting to emergency departments. Although the mortality rate associated with these presentations is low in the UK, they can lead to significant morbidity and prolonged hospital admissions. This review discusses new developments in the management of paracetamol overdose. Several new protocols for the infusion of acetylcysteine, the antidote for paracetamol overdose, have been proposed in the past decade and evaluated in clinical studies. The 12-hour Scottish and Newcastle Acetylcysteine Protocol regimen and 20-hour Australian two-infusion bag protocol have been widely adopted into clinical practice and endorsed in national guidelines because of their shorter duration, reduction in adverse effects and efficacy in treating overdose. This article includes a care pathway that can facilitate the implementation of the Scottish and Newcastle Acetylcysteine Protocol. This article also discusses the emergency management of ingested button batteries, describes the emerging threat of novel psychoactive substances, and provides an update on new UK antidote guidelines. Further up-to-date guidance on management of clinical toxicology is available to healthcare professionals on the internet database TOXBASE.