Accidental Exposure Research Articles

Canis lupus familiaris and diclofenac: understanding the potential risks of this association

In many homes worldwide, dogs are considered part of the family. Every possible care is given to animals, including drug treatments. However, many animal guardians, in an attempt to minimize pain or improve the quality of life of their dogs, provide drugs without a veterinarian’s prescription. Diclofenac, a non-steroidal anti-inflammatory drug that acts on cyclooxygenase-1 and cyclooxygenase-2 enzymes, is associated with several adverse events, especially related to the gastrointestinal tract, both in humans and pet animals. Therefore, the availability of information about the effects of this drug in different species is always essential. This narrative review aims to present adverse reactions the domestic dog (Canis lupus familiaris) can suffer when exposed to diclofenac. Scientific publications, books, and case reports were consulted, and inquiries were also carried out with regulatory agencies. Many reports of suspected adverse reactions, especially related to the gastrointestinal tract, were found. Other clinical manifestations and lesions were also identified in the cardiovascular system, liver, kidneys, and hematological examinations. Therefore, diclofenac may constitute a hazard to dogs, mainly due to possible damage to the gastrointestinal tract. This fact reinforces the need to seek veterinary advice before providing any drug to animals, in addition to recommendations on ensuring the correct storage of medications to avoid accidental exposure.

Evaluating the adverse drug reactions to clozapine in populations of children and adolescents: insights from VigiBase data.

Pharmacovigilance findings have marked clozapine use. Prescribers and package inserts worldwide focus on clozapine-induced neutropenia. The literature on clozapine adverse drug reactions (ADRs) for those under age 18 and their associated fatal outcomes is limited. Reports to the World Health Organization's global pharmacovigilance database (VigiBase) were analyzed among patients under 18 years of age extending from clozapine's introduction to June 1, 2022. There were 2825 reports of clozapine, including 42 fatal outcomes (relative lethality = 1.5% vs. 11.7% in all ages). After 280 cases were excluded (clozapine exposure during pregnancy, accidental exposure or unclear age), 2455 were included with ADRs during therapeutic use. Decreased white blood cell (WBC) count provided the most frequent aggregated ADR, accounting for 934 cases (37% of 2545), with only 1 fatal outcome (0.01%, 1/934). Suicide explained 7 of 27 (26%) non-duplicated fatal outcomes. Next in importance was clozapine-induced gastrointestinal hypomotility (CIGH) with 3 cases (11% of 27) and neuroleptic malignant syndrome with 2 cases (7% of 27). Agranulocytosis, aspiration, myocarditis, myocardiopathy and ventricular arrythmia led to single fatal cases. Based on these new findings and recent literature in all ages, to prevent fatal outcomes, child and adolescent psychiatrists need to shift their focus from severe neutropenia to other ADRs including pneumonia, respiratory aspiration and CIGH. In spite of its potential toxicity during overdoses, clozapine may have specific and strong anti-suicidal effects when compared with other antipsychotics. Child and adolescent psychiatrists need to take extreme precautions to avoid intentional overdoses when prescribing clozapine to patients with suicide risk.

Accidental exposure to blood (AEB), a real public health problem for medical and paramedical staff at the university hospital of mostaganem

Accidental exposure to blood (AEB), a real public health problem for medical and paramedical staff at the university hospital of mostaganem

Comparison of intranasal atipamezole by atomization or drops with intramuscular injection for reversing sedative effects of medetomidine in healthy dogs.

To determine and compare the efficacy of intranasal (IN) atomization, IN drops, and IM injection of atipamezole for reversal of medetomidine-induced sedation in healthy dogs. Prospective, randomized, blinded study. University teaching hospital. Forty mixed-breed, shelter-owned dogs with an average weight of 29.9±5.6kg (mean±SD) that required sedation for minor diagnostic or therapeutic procedures. Atipamezole was administered by a dog handler at 200µg/kg via IN atomization (ATI-INA, n=10), IN drops (ATI-IND, n=10), or IM injection (ATI-IM, n=10) 20minutes following medetomidine administration (40µg/kg). A control group (n=10) received no atipamezole. Ease of atipamezole administration was evaluated. Sedation score, heart rate (HR), respiratory rate (RR), and blood pressure (BP) were recorded pre-medetomidine administration (T0), pre-atipamezole administration (T20), and at multiple intervals following atipamezole administration. ATI-IM resulted in the fastest recovery, followed by ATI-INA, with ATI-IND being the slowest. The adverse cardiovascular impacts of medetomidine were not completely mitigated. ATI-IM showed initial HR restoration followed by a decline. HR in both IN groups showed a slower increase compared to ATI-IM, but no subsequent decline was observed. ATI-IM resulted in a transient decrease in BP, though dogs remained normotensive. A gradual reduction in BP was noted in the IN groups. At T50, RR of all atipamezole groups differed from control, and a significant increase in RR was observed in ATI-IM dogs compared to pre-atipamezole value. No adverse effects were observed. All routes for atipamezole administration effectively reversed medetomidine-induced sedation, with ATI-IM being fastest. IN routes were easy for the dog handler to administer, making them viable alternatives in cases of accidental drug exposure, particularly outside a hospital setting.

Attempt to re-estimate organ doses of victims in non-homogeneous exposure accident by means of the state-of-the-art Mesh-type Reference Computational Phantom-a case study of an IR-192 source accident.

An attempt was made to estimate organ doses of a victim in a high-dose non-homogeneous exposure accident caused by a sealed 192Ir gamma-ray source. The Gilan accident was selected as a case study. Organ doses including testis, red bone marrow and so on were properly estimated by applying the Monte Carlo calculation with the state-of-the-art adult male Mesh type Reference Computational Phantom. By introducing a complicated exposure scenario, the dose distribution on the right chest of the victim in the Gilan accident could be reproduced to a certain extent.

FDA warns against accidental overdose on fentanyl patches by children

“Accidental exposure to medication is a leading cause of poisoning in children,” the Food and Drug Administration (FDA) warned in a September 2024 announcement about fentanyl skin patches. “Young children, in particular, have died or become seriously ill after being exposed to a skin patch containing fentanyl, a powerful opioid pain reliever. If you suspect that a child has been exposed to a fentanyl patch, call 911 and seek emergency medical help immediately.

Navigating the Complexities of Radiation Injuries: Therapeutic Principles and Reconstructive Strategies.

Radiation injuries, particularly those resulting from therapeutic or accidental exposure, present complex challenges for medical management. These injuries can manifest localized skin damage or extend to deeper tissues, presenting as various clinical entities that require treatment strategies, ranging from conservative management to complex surgical interventions. Radiation treatment constitutes a fundamental component of neoplastic management, with nearly two out of three oncological instances undergoing it as an element of their therapeutic strategy. The therapeutic approach to radiation injury consists of expanding prophylactic measures while maintaining the efficacy of treatment, such as conservative treatment or local debridement followed by reconstruction. The armamentarium of reconstructive methods available for plastic surgeons, from secondary healing to free tissue transfer, can be successfully applied to radiation injuries. However, the unique pathophysiological changes induced by radiation necessitate a careful and specialized approach for their application, considering the altered tissue characteristics and healing dynamics. The therapeutic strategy is guided by both the severity and progression of the injury, with the primary aim of restoring functionality and aesthetic aspects while simultaneously minimizing the risk of complications. This paper explores the various conditions encompassed by the term "radiation injury," reviews both non-surgical and surgical therapeutic strategies for managing these injuries, and highlights the unique challenges associated with treating irradiated tissues within specific oncological contexts.

Epigenetic mechanisms of alveolar macrophage activation in chemical-induced acute lung injury.

Airways, alveoli and the pulmonary tissues are the most vulnerable to the external environment including occasional deliberate or accidental exposure to highly toxic chemical gases. However, there are many effective protective mechanisms that maintain the integrity of the pulmonary tissues and preserve lung function. Alveolar macrophages form the first line of defense against any pathogen or chemical/reactant that crosses the airway mucociliary barrier and reaches the alveolar region. Resident alveolar macrophages are activated or circulating monocytes infiltrate the airspace to contribute towards inflammatory or reparative responses. Studies on response of alveolar macrophages to noxious stimuli are rapidly emerging and alveolar macrophage are also being sought as therapeutic target. Here such studies have been reviewed and put together for a better understanding of the role pulmonary macrophages in general and alveolar macrophage in particular play in the pathogenesis of disease caused by chemical induced acute lung injury.

Exploring the Feasibility and Acceptability of Technological Interventions to Prevent Adolescents' Exposure to Online Pornography: Qualitative Research.

Amid growing concern over children's access to online pornography, policy makers are looking toward new and emerging technological concepts for unexplored solutions including artificial intelligence and facial recognition. This study sought to explore and ideate emerging technological interventions that are feasible, acceptable, and effective in preventing and controlling the exposure of young people to online pornographic material. We conducted a series of qualitative co-design workshops with both adult (n=8; aged 32-53 years) and adolescent participants (n=4; aged 15-17 years) to ideate potential technological interventions that are feasible, acceptable, and effective at preventing and controlling the exposure of young people to online pornographic material. A story stem methodology was used to explore participants' attitudes toward two unique technological prototypes. Participants expressed a generally favorable view of the proposed technological concepts but remained unconvinced of their overall utility and effectiveness in preventing the intentional viewing of pornography by young people. Age-appropriate parent-child conversations remained participants' preferred approach to mitigating potential harms from pornographic material, with parents also expressing a desire for more educational resources to help them better navigate these discussions. User privacy and data security were a primary concern for participants, particularly surrounding the use and collection of biometric data. Internationally, policy makers are taking action to use age assurance technologies to prevent children's access to online pornography. It is important to consider the needs and opinions of parents and young people in the use and implementation of these technologies. Participants in this study were generally supportive of new and emerging technologies as useful tools in preventing the accidental exposure of young people to online pornographic material. However, participants remained less convinced of their ability to avert intentional viewing, with substantial concerns regarding technological efficacy, adaptability, and user privacy. Further, co-design and prototype refinement are needed to better understand user acceptability and comfortability of these new technological interventions, alongside additional research exploring sociocultural differences in information needs and user experiences.

Heat Treatment of Saliva to Reduce Infectious Disease Contamination Does Not Impact the Analysis of Melatonin by Radioimmunoassay.

The determination of melatonin levels in saliva represents one of the key methods for assessing the timing of the central circadian clock in humans, both in research and clinical settings. Melatonin levels in saliva are typically determined in a laboratory setting by RIA or enzyme-linked immunosorbent assay and the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented a serious challenge to the routine, safe assessment of melatonin in saliva samples. However, SARS-CoV-2 present in biological fluids can be inactivated by exposure to temperatures of at least 55-60°C for 30 min and the aim of this study was to assess the validity of applying a pretreatment heating step to saliva samples being prepared for melatonin determination using the Novolytix Radioimmunoassay (RK-DSM2). 40 archived saliva samples collected under a Dim Light Melatonin Onset sampling protocol were thawed and aliquoted into three identical groups-Controls (no pretreatment), 56°C pre-assay heat-treatment (30 min), and 70°C pre-assay heat-treatment (30 min). Melatonin concentrations in samples that were heated to 56°C for 30 min before assaying showed close agreement with the untreated controls, with the Pearson's correlation coefficient between the two sets of samples of 0.99 (p < 0.0001) and the slope of the Deming regression analysis close to 1.0 (Y = 1.04X + 0.168). When saliva samples were pretreated to 70°C for 30 min before assaying, the subsequent melatonin determinations were still strongly correlated with the untreated controls (Pearsons correlation coefficient = 0.97 (p < 0.0001), however melatonin concentrations were consistently overestimated when compared to the untreated controls with Deming regression slope of Y = 1.26X + 0.241. These results indicate that a 56°C pretreatment step is suitable for inclusion in standard operating protocols for melatonin determinations using the Novolytix RIA, as a way of effectively minimizing the potential for accidental pathogen exposure while handling saliva samples.

A data mining approach to identify key radioresponsive genes in mouse model of radiation-induced intestinal injury

Background Radiation-mediated GI injury (RIGI) is observed in humans either due to accidental or intentional exposures. This can only be managed with supporting care and no approved countermeasures are available till now. Early detection and monitoring of RIGI is important for effective medical management and improve survival chances of exposed individuals. Objective The present study aims to identify new signatures of RIGI using data mining approach followed by validation of selected hub genes in mice. Methods Data mining study was performed using microarray datasets from Gene Expression Omnibus database. The differentially expressed genes were identified and further validated in total-body irradiated mice. Results Based on KEGG pathway analysis, lipid metabolism was found as one of the predominant pathways altered in irradiated intestine. Extensive alteration in lipid profile and lipid modification was observed in this tissue. A protein–protein interaction network revealed top 08 hub genes related to lipid metabolism, namely Fabp1, Fabp2, Fabp6, Npc1l1, Ppar-α, Abcg8, Hnf-4α, and Insig1. qRT-PCR analysis revealed significant up-regulation of Fabp6 and Hnf-4α and down-regulation of Fabp1, Fabp2 and Insig1 transcripts in irradiated intestine. Radiation dose and time kinetics study revealed that the selected 05 genes were altered differentially in response to radiation in intestine. Conclusion Finding suggests that lipid metabolism is one of the key targets of radiation and its mediators may act as biomarkers in detection and progression of RIGI.

Apigenin's Influence on Inflammatory and Epigenetic Responses in Rat Lungs After Radiotherapy.

The lung is a moderately radio-sensitive organ. When cells are damaged due to accidental radiation exposure or treatment, they release molecules that lead to the recruitment of immune cells, accumulating inflammatory cytokines at the site of damage. Apigenin (Api) is a natural flavonoid known for its anti-inflammatory properties. In this study, we investigated the radioprotective properties of Api in the lung. Thirty-six Wistar rats were randomly assigned to nine groups: control, radiation (Rad), CMC+Rad, Api10+Rad, and Api20+Rad. Api was administered with an intraperitoneal injection for 7 days, after which the rats were irradiated with 6 Gy whole-body X-ray. At 6 and 72 hours post-irradiation, the rats were euthanized, and their lung tissue was extracted. Radiation led to increased alveolar wall thickness and the infiltration of macrophages and lymphocytes. Furthermore, the expression levels of inflammatory factors such as a nuclear factor of kappa light polypeptide gene enhancer in B-cells (NF-ĸB), Glycogen synthase kinase-3 beta (GSK-3β), transforming growth factor-beta1 (TGF-β1), and epigenetic factors including DNA methyltransferase 3a (DNMT3a) and Histone deacetylase 2 (HDAC2) were elevated in the lung tissue following radiation. Meanwhile, the expression level of IκB-α decreased. However, administration of Api (at both 10&20 mg/kg) reversed the adverse effects of radiation. Api administration mitigated radiation-induced lung damage by reversing inflammatory and epigenetic changes.

Law enforcement officer perceptions of the Good Samaritan law and their role in the opioid epidemic in the United States

PurposeGood Samaritan laws were enacted to reduce overdose deaths by lowering the barriers to reporting for victims and witnesses and allowing law enforcement officers to carry and administer Narcan to those suspected of an opioid-related overdose The purpose of this study is to understand how officers perceive the impact of opioid overdose reduction initiatives in the United States and their role in the opioid epidemic.Design/methodology/approachMixed methods were used in two phases to examine perceptions among law enforcement officers in a Massachusetts police department. First, qualitative methods were used to interview nine patrol officers during participant observations in the form of ride-alongs. Second, patrol officers and officers who volunteer with the department opioid outreach program were surveyed.FindingsOfficers generally held mixed feelings about the state’s Good Samaritan law. They saw the importance of saving the lives of those experiencing an overdose and keeping other first responders safe, but also in enforcing laws against possession of illegal drugs that presents a public safety threat, including the accidental exposure to fentanyl. Despite mixed feelings, officers still believed it to be important that they are trained and able to administer Narcan since they are often the first to arrive on scene.Originality/valueThis study adds to the research on officers’ perceptions of their role in the opioid epidemic, their ability to administer Narcan and the impact of Good Samaritan laws on their community.

Severe Salicylate Poisoning Due to Teaberry Flavoring Ingestion: A Case Report

BackgroundCurrently there are many commercial uses of methyl salicylate including fragrances, flavoring, topical pain relief, and polymer restoration. Most recorded instances of human toxicity due to methyl salicylate are the result of topical or accidental exposures. However, this is a previously unreported case of an adult patient who intentionally ingested teaberry flavoring causing life-threatening salicylism. Case ReportA 22-year-old man presented to the Emergency Department with the chief complaint of nausea, vomiting and abdominal pain. Triage nursing noted the patient's vomit smelled strongly of wintergreen. Further history indicated the patient had ingested approximately 40 mL of teaberry oil while using it to make ice cream. The initial serum salicylate concentration was 111 mg/dL. The medical toxicology team was consulted, and the patient was given a singular dose of activated charcoal by mouth. He was also administered both an intravenous sodium bicarbonate bolus and sodium bicarbonate infusion. He was admitted to the intensive care unit while the nephrology service was consulted to initiate emergent hemodialysis (hD). After the single hD treatment with concomitant serum and urine alkalization, the patient had progressive improvement of salicylate concentrations. He was discharged on hospital day three in normal condition. Why should an emergency physician be aware of this?Emergency physicians should be aware of novel etiologies of life-threatening salicylate poisoning.

Custard apple seeds (Annona squamosa)-induced bilateral toxic keratopathy

Custard apple seeds are a natural remedy for head lice infestation in some parts of India. We report a case of a patient with accidental bilateral ocular exposure to custard apple seeds powder. The patient developed toxic bilateral keratopathy, which was treated with topical antibiotics, lubricants, and low-dose steroids. The patient responded well to the treatment. This report is intended to educate the patients regarding the potential toxic effects of custard apple seeds and increase the awareness of public on traditional harmful practices in this regard.

Fortuitous tarsorrhaphy: Management of accidental cyanoacrylate glue exposure in the eye

Fortuitous tarsorrhaphy: Management of accidental cyanoacrylate glue exposure in the eye

Peanut Allergy in Children-Is Prevention Better than Cure?

Peanut allergy, one of the most frequently occurring allergies, usually starts in childhood and rarely subsides-often persisting throughout adult life. Accidental exposure to peanuts can often result in adverse reactions ranging from mild to life-threatening, such as anaphylactic shock. Historically, food avoidance and the use of rescue drugs have remained a fundamental management mechanism for dealing with food allergy. However, prevention of adverse reactions to food allergy is playing an increasing role. This is possible through the early introduction of peanuts into the diet, especially in infants at risk of this allergy. In recent years, specific immunotherapy has been used to develop desensitisation and, in some patients, tolerance-defined as a persistent state of clinical non-reactivity to the allergen after therapy is finished. The aim of this article is to summarise the current state of knowledge on the prevention and treatment of peanut allergy, with a focus on clinical trials, current guidelines, and recent experimental studies. This review may be particularly useful for paediatricians and general practitioners.

Estimating the Concentration of Heavy Metals in Oleander/Pink and white Oleander Plants

Oleander is a large ornamental evergreen shrub that may grow 20–25 ft in height. During the summer months’ large clusters of white, pink, red, or yellow (yellow oleander) flowers appear at the ends of the branches. All parts of the plant contain cardiac glycosides. Oleander is a common source of serious plant poisoning. In South Asia, particularly Sri Lanka, also present in Libya desert and some house gardens with white and pink types, oleander has become a notorious method of suicide. Toxicity is largely characterized by gastrointestinal symptoms and cardiac abnormalities. Tachy or bradydysthythmias may be present in addition to slowed conduction and heart block. Hyperkalemia is common and correlates with severity of poisoning. A specific antidote—digoxin-specific fragment antigen-binding region (Fab region)- is available. In Mediterranean climates oleanders can be expected to bloom from April through October, with the heaviest bloom usually occurring between May and June. Free-flowering varieties like 'Petite Salmon' or 'Mont Blanc' require no period of rest and can flower continuously throughout the year if the weather remains warm. The exact nature of plant poisoning varies from region to region, but certain plants are almost ubiquitous in distribution and among these, Oleander is a garden plant that features in many homes. Incidents of poisoning from these plants are therefore not uncommon and may be the result of accidental exposure or deliberate, suicidal ingestion of the toxic parts. An attempt has been made to review the management principles with regard to toxicity of these plants and survey the literature in order to highlight current concepts in the treatment of poisoning resulting from both plants. Ingestion of its seeds results in a clinical picture similar to digoxin toxicity. It contains cardiac glycosides that are toxic to cardiac myocytes and autonomic system. Cardiac glycosides of oleander cause poisoning by inhibiting plasmalemmal Na+/K+-ATPase. Results: The poisoning effects of plant or their active alkaloids induced infiltration of cells with hemorrhage and sever negative changes in the lung, induce lesions, and infiltration of inflammatory cells into the portal spaces with scattered necrosis of hepatocytes in the liver, cardiac toxicity of the plant in the heart were included, induced varying degrees of hemorrhage, myocardial degeneration, and necrosis. It also induced arrhythmia, sinus bradycardia, and prolonged P-R interval in electrocardiographic records. Conclusions: The toxic effects of N. oleander are mostly related to its inhibitory effects on the Naþ-Kþ ATPase pump in the cellular membrane. However, the exact molecular mechanism involved in the toxicity of N. oleander is not clear.

Predictive factors for tuberculous peripheral pulmonary lesions during radial endobronchial ultrasound

BackgroundTuberculosis frequently poses diagnostic challenge when it presents as a peripheral pulmonary lesion (TB-PPL). The growing use of radial endobronchial ultrasound (rEBUS) for PPL biopsy highlights the need to identify predictive factors for TB-PPL, which is crucial for procedure safety. MethodsA six-year retrospective review at our institution on adult patients with TB and malignant-PPL diagnosed from rEBUS procedure from October 1, 2016, to December 31, 2022. Clinical, radiological, procedural, histological and microbiological data were extracted and analysed. Results387 PPLs were included in our cohort, 32 % were TB-PPL and 68 % were malignant-PPL. The median age was 63 (IQR 55–70) years, with the TB-PPL group significantly younger. The median size of the target lesion was 2.90 (IQR 2.26–4.00) cm. The overall rEBUS diagnostic yield was 85.3 %, with a 1.3 % pneumothorax risk. Multivariate analysis identified independent predictors for TB-PPL, including age <60 years (adj OR 2.635), target lesion size <2 cm (adj OR 2.385), upper lobe location (adj OR 2.020), presence of a cavity on pre-procedural CT (adj OR 4.186), and presence of rEBUS bronchogram (adj OR 2.722). These variables achieved an area under the curve of 0.729 (95 % CI 0.673–0.795) with a diagnostic accuracy of 75.49 % (95 % CI 70.68–79.88). ConclusionsDespite non-specific radiological findings in TB-PPL, our study identifies younger age, target lesion size less than 2 cm, upper lobe location, the presence of cavitation, and rEBUS bronchogram were independent clinical predictors for TB-PPL. This prediction model potentially helps mitigate the risk of accidental TB exposure during bronchoscopic procedures. A future prospective cohort study to validate these findings is essential to allow proper triaging of patient planning for rEBUS procedure.

Impact of Ionizing Radiation Exposure on Placental Function and Implications for Fetal Programming.

Accidental exposure to high-dose radiation while pregnant has shown significant negative effects on the developing fetus. One fetal organ which has been studied is the placenta. The placenta performs all essential functions for fetal development, including nutrition, respiration, waste excretion, endocrine communication, and immunological functions. Improper placental development can lead to complications during pregnancy, as well as the occurrence of intrauterine growth-restricted (IUGR) offspring. IUGR is one of the leading indicators of fetal programming, classified as an improper uterine environment leading to the predisposition of diseases within the offspring. With numerous studies examining fetal programming, there remains a significant gap in understanding the placenta's role in irradiation-induced fetal programming. This review aims to synthesize current knowledge on how irradiation affects placental function to guide future research directions. This review provides a comprehensive overview of placental biology, including its development, structure, and function, and summarizes the placenta's role in fetal programming, with a focus on the impact of radiation on placental biology. Taken together, this review demonstrates that fetal radiation exposure causes placental degradation and immune function dysregulation. Given the placenta's crucial role in fetal development, understanding its impact on irradiation-induced IUGR is essential.