Cases Of Poisoning Research Articles

The Correlation of Bile Duct Dilatation in Postmortem Computed Tomography of Lethal Intoxication Cases for Different Drug Types—A Retrospective Study

Purpose: To assess (I) whether, in autopsy-proven lethal intoxications with opiates/opioids, a dilatation of the common bile duct (CBD) is still visible in postmortem computed tomography (PMCT) and (II) if a dilatation of the CBD might also be measurable for other substance groups (e.g., stimulants, hypnotics, antipsychotics, etc.). Methods: We retrospectively measured the CBD using PMCT in cases with lethal intoxication (n = 125) and as a control group in cases with a negative toxicological analysis (n = 88). Intoxicating substances were classified into the subgroups (opiates, opioids, stimulants, hypnotics, antipsychotics, gasses, and others). Significance between the study and control groups was tested with the Mann–Whitney U test, and correlations were examined by using crosstables. Results: There was a statistically significant difference between the CBD diameters in the intoxication group overall, when compared to the CBD diameter in the control group (p < 0.001). For both subgroups of “opiates” and “opioids”, there was a strong statistically significant difference between the CBD diameter (being wider) in those groups compared to the control group (both p = 0.001). For the three subgroups “hypnotics”, “stimulants”, and “psychotropic drugs”, there was no statistically significant difference between the CBD diameters in the intoxication subgroups when compared with the control group. The other subgroups were too small for statistical analysis. Conclusion: A dilated common bile duct in postmortem computed tomography might be used as an indication for a lethal opioid or opiate intoxication only in regard to the specific case circumstances or together with other indicative findings in a postmortem investigation.

Genomic perspectives on foodborne illness

Whole-genome sequencing of bacterial pathogens is used by public health agencies to link cases of food poisoning caused by the same source of contamination. The vast majority of these appear to be sporadic cases associated with small contamination episodes and do not trigger investigations. A "contamination episode" refers to one or more contamination events from a single source over a period of time. We examine clusters of sequenced clinical isolates of Salmonella, Escherichia coli, Campylobacter, and Listeria that differ by only a small number of mutations (SNPs) to identify features of the underlying contamination episodes. These analyses provide additional evidence that the youngest age groups have greater susceptibility to infection by Salmonella, E. coli, and Campylobacter than older age groups. This age bias is weaker for the common Salmonella serovar Enteritidis than Salmonella in general. A large fraction of the contamination episodes causing sickness appear to have a long duration. For example, 50% of the Salmonella cases are in clusters that persist for almost 3 y. For all four pathogen species, the majority of the cases were part of genetic clusters with illnesses in multiple states and likely to be caused by contaminated commercially distributed foods. Salmonella infections in infants under 3 mo are predominantly acquired from the same contaminated food, pet food, or environmental sources as older individuals, rather than infant formula contaminated during production.

L’intoxication au protoxyde d’azote : un nouveau défi pour la biologie médicale

AbstractNitrous oxide (N2O) is a gas used in medicine for its anesthetic and analgesic properties, and in industry as an oxidizing gas or propellant. This gas is also available on self-service for food use. In recent years, its use has been increasingly diverted to recreational purposes. Between 2020 and 2021, the number of serious cases of intoxication increased by 320% in France, demonstrating a major public health concern. It is also a problem for road safety, with an increase in the number of road accidents linked to the consumption of this gas. Nitrous oxide causes both short-term effects (euphoria, disorientation, etc.) and long-term effects (sensory and motor neurological disorders and thrombosis). This gas acts on the central nervous system, inducing anxiolytic, anesthetic, antidepressant and analgesic effects. Nitrous oxide is difficult to quantify because of its rapid elimination. Biological investigation is thus based on secondary anomalies linked to vitamin B12 inactivation: increased methylmalonic acid and homocysteine levels. However, these two biological markers are not specific to nitrous oxide intoxication. To improve patient support, we need to find new biological markers that are more specific to nitrous oxide intoxication.

Datura stramonium seed ingestion leading to unintentional poisoning in a 3-year-old Ethiopian toddler: case report

IntroductionDatura stramonium poisoning, resulting from the ingestion of seeds, leaves, or flowers of Datura stramonium, is a severe condition with significant risks, particularly for young children. Most documented cases of Datura stramonium poisoning in the literature involve teenagers who intentionally ingest the plant to induce hallucinogenic and euphoric experiences. This report presents a rare instance of unintentional Datura stramonium poisoning in a 3year-old Ethiopian toddler.Case presentationHe presented with symptoms consistent with anticholinergic toxidrome, including altered mental status, agitation, seizures, dilated pupils, and tachycardia. Laboratory tests, including complete blood count, liver function test, renal function test, electrolyte levels and cerebrospinal fluid analysis were normal. Results of blood toxicology screen were negative. Timely recognition and supportive care lead to a positive outcome.ConclusionThrough this report, we aim to add to the limited body of literature on Datura stramonium poisoning in toddlers and offer insights into its clinical course and management in paediatric patients.

Voluntary Victim Intoxication in Sexual Assault State Statutes: A Content Analysis.

Recent events, such as the #Metoo movement, have renewed sexual assault victims calls for change. Legal change has, unfortunately, been slow for sexual assault survivors who were voluntarily intoxicated during their victimization. To understand the legal remedies available for voluntarily intoxicated victims', this study explored state sexual assault laws across the United States of America. The results indicate that there exist significant shortcomings in the interpretation of and evidentiary requirements in voluntary victim intoxication cases. Policy implications from these results are discussed in the hopes of providing voluntarily intoxicated sexual assault victims greater access to justice.

Insulin in aluminum phosphide poisoning: A systematic review of the current literature.

Aluminum phosphide (AlP) is a commonly used fumigant in agriculture and grain preservation because of its high potency and low cost. Due to the absence of a specific antidote and promising treatment modality, poisoning with this substance is deadly. Amid multiple studies in different parts of the world, each exploring options like lavage, inotropes, antioxidants, etc, we conducted a systematic review to find the possible role of exogenous insulin in treating symptomatic cases of AlP poisoning. Experimental studies released before February 15, 2024, that reported the use of exogenous insulin were systematically reviewed following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The search was done on PubMed Central, Cochrane Library, and Google Scholar. After applying the inclusion and exclusion criteria, we finalized a few scientific papers for the review. Studying data from 4 scientific papers (3 quasi-experimental studies and 1 randomized controlled trial), we could postulate the significant improvement in survivability after the inclusion of exogenous insulin in the treatment of poisoned cases of AlP. Studies showed divergent results for the blood pressure, blood gases, and need for mechanical ventilation. Hypoglycemia, hyperglycemia, and hypokalemia were the reported adverse effects of this therapy. Our review found that the use of exogenous insulin in AlP poisoning reduced mortality rates, which was consistent across all studies. With available knowledge, its inclusion as a part of therapy might be beneficial in AlP poisoning, but to put it forward confidently, we still need high-quality randomized control trials. It is indeed a subject of interest for future research.

Paediatric opioid poisoning in the UK: a retrospective analysis of clinical enquiries to the National Poisons Information Service

ObjectiveTo evaluate a decade of reported paediatric opioid poisoning cases in the UK.MethodsThe National Poisons Information Service (NPIS) telephone enquiries database (UK Poisons Information Database) was searched for calls regarding...

The Lethal Lure of Thallium: A Case Report

Thallium toxicity is often missed due to its rarity. We present a case of thallium poisoning in a 29-year-old who presented with features consistent with the Guillain-Barré syndrome. He was treated successfully with Prussian blue, hemoperfusion, and hemodialysis.

Characterization of the Bacillus cereus Group Isolated from Ready-to-Eat Foods in Poland by Whole-Genome Sequencing.

Bacillus cereus sensu lato can contaminate food and cause food poisoning by producing toxins such as cereulide, toxin BL, and cytotoxin K. In this study, we retrospectively analyzed B. cereus sensu lato from retail food products and food poisoning cases using PCR methods to determine their virulence profiles. A new toxin profile, encoding all four toxins (hbl, nhe, cytK, ces), was found in 0.4% of isolates. The toxin profiles, classified into A-J, revealed that 91.8% harbored nhe genes, while hbl, cytK, and ces were detected in 43.8%, 46.9%, and 4.2% of isolates, respectively. Whole-genome sequencing (WGS) identified four distinct species within the B. cereus group, with 21 isolates closely related to B. cereus sensu stricte, 25 to B. mosaicus, 2 to B. toyonensis, and 1 to B. mycoides. Three novel sequence types (STs 3297, 3298, 3299) were discovered. Antibiotic resistance genes were common, with 100% of isolates carrying beta-lactam resistance genes. Fosfomycin (80%), vancomycin (8%), streptothricin (6%), tetracycline (4%), and macrolide resistance (2%) genes were also detected. These results highlight the genetic diversity and antibiotic resistance potential of B. cereus sensu lato strains in Polish food products.

Epidemiological characteristics and toxicant type of acute poisoning cases in China, 2016-2022

Objective: To analyze the acute poison epidemic and provide evidence for developing prevention and control strategies for acute poisoning. Methods: A retrospective analysis was conducted on acute poisoning cases collected from 2016 to 2022 in a health emergency information platform for acute poisoning accidents. The cases were grouped according to the distribution of poisoning occurrence time, geographic distribution, demographic distribution, types of toxicants, poisoning causes, and outcomes. Data were organized and analyzed using Excel 2016 and R 4.2.3. Results: A total of 95 754 acute poisoning cases were included in this study. The primary toxicants were pesticides, drugs, and industrial/household chemicals, accounting for 30.4%, 22.4%, and 20.4% of the total cases, respectively. Acute poisoning occurred throughout the year, with the highest frequency from June to August, accounting for 31.9%. The seasonal distribution varied among different types of toxicants. Except for plant poisoning, which showed a bimodal distribution, the other poisonings showed an unimodal distribution. There was a strong seasonality in fungal poisoning, which peaked in July. There was an obvious seasonality in animal poisoning, with a peak in August. The proportion of biological poisonings in the southwest region was higher than in other regions, including plants, animals, and fungi. There were more females than males, and their education level was mainly junior high school and below (35.2%). The main occupation was farmers (34.2%), and the main causes of poisoning were accidents and suicides. The case fatality rate of all poisoning cases was 1.24%. Pesticide poisoning was the most common type, and chlorfenapyr (11.68%), Diquat (7.23%), and paraquat (7.05%) ranked as the top three toxicants. Conclusions: The occurrence of acute poisoning has an obvious seasonal trend, and the toxicant spectrum of different regions and populations is different. A comprehensive poisoning surveillance system can provide a better understanding of the occurrence of poisonings, and facilitate the formulation of more scientifically precise poisoning prevention and control strategies.

Acute Corrosive Acid Ingestion: A Case Series of Four Autopsies

Acute corrosive acid ingestion presents significant challenges in clinical and forensic pathology due to its severe and often fatal outcomes. This case series examines four autopsies involving fatal acid ingestion: three cases of hydrochloric acid (HCl) poisoning and one case of sulfuric acid (H₂SO₄) poisoning. Each case provides detailed autopsy findings, focusing on macroscopic and microscopic pathological changes. The first three cases of HCl poisoning revealed extensive tissue damage characterized by coagulative necrosis, particularly affecting the esophagus, stomach, and duodenum. Histological examination showed dense inflammatory infiltrate, submucosal edema, and significant hemorrhage, with patchy necrosis observed in the liver and kidneys. Pulmonary findings included alveolar edema and hemorrhage. The fourth case, involving H₂SO₄ ingestion, demonstrated more severe injuries with transmural necrosis and extensive hemorrhagic infiltration in the esophagus. The stomach exhibited full-thickness necrosis with a pronounced sulfurous odor, indicating severe chemical injury. Histopathological findings included extensive tissue dehydration and charring, with severe alveolar edema and hemorrhage in the lungs and extensive necrosis in the liver and kidneys. Comparative analysis of the histopathological changes highlighted the differences in tissue damage caused by these two acids. HCl primarily induced superficial necrosis with relatively preserved tissue architecture, while H₂SO₄ caused more extensive and deeper tissue damage due to its strong dehydrating and exothermic properties. Recognizing these differences is crucial for forensic pathologists in accurately diagnosing and differentiating cases of acid poisoning, ultimately enhancing diagnostic precision and clinical outcomes. This study underscores the severe and often fatal consequences of acute acid ingestion and aims to enhance the understanding of the pathological changes associated with such poisonings, thereby improving forensic and clinical evaluations.

Clinical characteristics and toxicological spectrum analysis of 493 cases of acute poisoning in children

ObjectiveThis retrospective study aimed to analyze the clinical characteristics and toxicological spectrum of acute poisoning in children treated at our pediatric intensive care unit. The findings provide a basis for the treatment and prevention of acute poisoning in children.MethodsClinical data of hospitalized children aged 0 to14 years with acute poisoning, treated between January 2015 and December 2023, were collected and analyzed. The analysis included the types of poisoning, sex and age distribution of children, routes and causes of poisoning, time from poisoning to medical consultation, length of hospital stays, and treatment outcomes.ResultsAmong the 493 cases of acute poisoning in children, pesticide poisoning (n = 252, 51.1%) was the most common type, followed by medication poisoning (n = 182, 36.9%). Chemical poisoning accounted for 7.7% (n = 38), while food poisoning and inhalation of harmful gases accounted for 3.0% (n = 15) and 1.2% (n = 6), respectively. The main route of poisoning was oral ingestion (n = 477, 96.8%), while accidental ingestion accounted for a large proportion (n = 379, 79.4%), and adolescents aged 11 to 14 years accounted for 20.6% (n = 98).Apart from the predominance of girls attempting suicide by self-administering antipsychotic medications (n = 88, 75.9%) due to depression, there was no significant difference in sex distribution among other types of poisoning children. The highest incidence of poisoning except children who self-administer antipsychotic drugs occurred in children aged 1–3 years (n = 267, 54.2%) and 8–14 years (n = 135, 27.4%), with the highest proportion in the preschool age group. The average time from poisoning to medical consultation was 33.4 ± 54.9 h, and majority of children received treatment within 48 h after poisoning (n = 423, 85.8%). The overall effective treatment rate was 96.8%.ConclusionAcute poisoning in children has complex and diverse causes, with accidental ingestion being the main route. Prevention should be emphasized, including strengthening child safety education and improving parental supervision. Moreover, psychological health education is crucial for adolescents during their puberty. In the event of acute poisoning, prompt medical consultation and appropriate treatment are necessary to mitigate adverse outcomes.

Real-time Deep Learning Based Mobile Application for Detecting Edible Fungi: Mushapp

Mushroom consumption and wild mushroom gathering are increasing in our country and in the world. Mushroom poisoning has an important place in food poisoning cases. Mushroom poisoning accounts for approximately 7% of poisoning cases in adults. Mushroom collection and consumption is common in many regions of our country. In this study, a deep learning based mobile application was developed to reduce the incidence of mushroom poisoning by taking a photo of a mushroom and determining the type and toxicity of the mushroom from the photo. This mobile application is called MushAPP. In the first phase of the study, 5150 mushroom images of 20 mushroom species were used to create the dataset. The dataset was then pre-processed and converted into a format that can be used by the deep learning algorithm. The mobile application side of the project was developed in Android Studio IDE environment. An artificial intelligence model was integrated into the designed mobile application. In the application, the type and toxicity status of the mushroom viewed from the mobile device camera are determined and presented to the user. The research findings were analyzed and it was determined that the accuracy rate of the application in detecting the mushroom species was 99.8%.

In vitro and in vivo study of butyrylfentanyl and 4-fluorobutyrylfentanyl in female and male mice: Role of the CRF1 receptor in cardiorespiratory impairment.

Fentanyl analogues have been implicated in many cases of intoxication and death with overdose worldwide. The aim of this study is to investigate the pharmaco-toxicology of two fentanyl analogues: butyrylfentanyl (BUF) and 4-fluorobutyrylfentanyl (4F-BUF). In vitro, we measured agonist opioid receptor efficacy, potency, and selectivity and ability to promote interaction of the μ receptor with G protein and β-arrestin 2. In vivo, we evaluated thermal antinociception, stimulated motor activity and cardiorespiratory changes in female and male CD-1 mice injected with BUF or 4F-BUF (0.1-6 mg·kg-1). Opioid receptor specificity was investigated using naloxone (6 mg·kg-1). We investigated the possible role of stress in increasing cardiorespiratory toxicity using the corticotropin-releasing factor 1 (CRF1) antagonist antalarmin (10 mg·kg-1). Agonists displayed the following rank of potency at μ receptors: fentanyl > 4F-BUF > BUF. Fentanyl and BUF behaved as partial agonists for the β-arrestin 2 pathway, whereas 4F-BUF did not promote β-arrestin 2 recruitment. In vivo, we revealed sex differences in motor and cardiorespiratory impairments but not antinociception induced by BUF and 4F-BUF. Antalarmin alone was effective in blocking respiratory impairment induced by BUF in both sexes but not 4F-BUF. The combination of naloxone and antalarmin significantly enhanced naloxone reversal of the cardiorespiratory impairments induced by BUF and 4F-BUF in mice. In this study, we have uncovered a novel mechanism by which synthetic opioids induce respiratory depression, shedding new light on the role of CRF1 receptors in cardiorespiratory impairments by μ agonists.

Острые интоксикации в условиях химических производств и меры профилактики

Occupational diseases caused by the chemical factor, including acute intoxications, continue to be reported in enterprises of the petrochemical industry. In this regard, studying the etiological factor causing acute intoxication, as well as the circumstances and causes of its occurrence among various professional groups of employees is still urgent. A retrospective analysis of materials of the investigation of occupational diseases caused by acute intoxications that occurred within 50 years (from 1967 to 2022) at the largest petrochemical plant located in the Volga Federal District has been conducted. An in-depth analysis of acute occupational disease risk indicators at the plant has shown that for the analyzed period, 124 cases of acute occupational poisonings, both collective and with one victim were reported. The high professional risk of health disorders due to acute poisonings has been detected for employees of the main professions: operators, machinists, and process equipment repair mechanics. The most significant factors causing acute poisonings were ammonia (23.4 % of all cases), hydrogen sulfide (17.3 %), carbon monoxide (10.7 %), and aromatic hydrocarbons (9.8 %). The main areas of chemical factor risk minimization have been developed based on the analysis.

A Case of Multidrug Intoxication Including Calcium Channel Blocker Treated with Plasmapheresis

A Case of Multidrug Intoxication Including Calcium Channel Blocker Treated with Plasmapheresis

Food Poisonings at Hotels, Tripadvisor Reviews in Türkiye

Tourists travel long distances and visit attractive destinations. Problems that may occur in these destinations may affect visit preferences. Food poisoning is one of the health problems that may encounter during their holidays, which will create negative memories about their holidays. In this study, comments about food poisoning cases made by foreign tourists visiting Türkiye were examined. In this way, the points to be taken into consideration for hotels to avoid food poisoning cases will be revealed. Tourist comments on the Tripadvisor website constitute the examination area of the study. The study covers comments made between 2012 and 2022. The study is a qualitative research and 731 comments containing the concept of "food poisoning" on Tripadvisor were subjected to text/content analysis to obtain the data set. After the analysis, themes and categories associated with the subject of "food poisoning" were determined. The themes of these categories are “food safety, illness, staff attitude, feelings, cause and vulnerable”. Accommodation business managers should pay attention to these issues in order to reduce food poisoning complaints and prevent the formation of a negative image.

Kanamycin promotes biofilm viability of MRSA strains showing extremely high resistance to kanamycin

Staphylococcus aureus is widely distributed in environment and can cause various human infection and food poisoning cases. Also, this pathogen is a typical biofilm former, which further complicates its pathogenicity. Antibiotics have been widely used to eliminate pathogenic bacteria, but their indiscriminate use has also led to the widespread emergence of drug-resistant bacteria, such as Methicillin-Resistant Staphylococcus aureus (MRSA). In this study, the effect of antibiotics on biofilm formation of MRSA strains 875 and 184 was explored. Firstly, MRSA 875 belongs to SCCmec type IV, ST239, carrying the atl, icaA, icaD, icaBC, and aap genes, and MRSA 184 belongs to SCCmec type II, ST5, carrying the atl, icaD, icaBC, aap, and agr genes. Then, a total of 8 antibiotics have been selected, including kanamycin, gentamycin, cipprofloxacin, erythromycin, meropenem, penicillin G, tetracycline, vancomycin. Minimum inhibitory concentrations (MICs) of each antibiotic were determined, and MIC of MRSA 875 and 184 to kanamycin/gentamicin are 2048/64 μg/mL and 2048/4 μg/mL, respectively. A total of 10 concentrations, ranging from 1/128 to 4 MIC with 2-fold, were used to study biofilm formation. Biofilm biomass and viability were determined during different phases, including initial adhesion (8 h), proliferation (16 h), accumulation (24 h) and maturation (48 h). Importantly, kanamycin at specific concentrations showed significant promotion of biofilm biomass and biofilm viability, with none of such observation acquired from other antibiotics. This study provides scientific basis and new research ideas for the quality control technology of microorganisms and safety prevention of MRSA.

A Rare Case of Occupational Aniline Poisoning: Management in a Limited-Facility Setting

Introduction Cyanosis along with altered mental should bring all the possible ethiologies into her mind in a minimum of time, based on the trauma, medical, environmental, and occupational history of the patient. Poisoning with methemoglobinemia inducing agents is one of the most important differentials especially when a history of occupational exposure to these agents is present. Case Report The patient, a 41-year-old healthy woman and engineer, experienced symptoms after exposure to aniline leading to dizziness and weakness, prompting a visit to the emergency department with cyanosis and low oxygen saturation. Initial vital signs showed decreased oxygen levels and elevated respiratory rate with normal ABG values despite ongoing cyanosis. Patient required intubation, mechanical ventilation, and was diagnosed with ARDS based on chest X-ray findings. Management included IV diuretics, 100% oxygen, and antioxidant treatment in the ICU. Despite treatment, oxygen saturation remained at 88% on the first day. Conclusion This case is a reminder of the importance of taking occupational history and management of aniline toxicity in a setting where methylene blue, the drug of choice for aniline toxicity, is not available in the drug stock.

Study on the correlation between the number of mushroom poisoning cases and meteorological factors based on the generalized additive model in Guizhou Province, 2023

BackgroundMushroom poisoning is a significant food safety issue in Guizhou Province, China. Studies on this topic are essential for its prevention and control. We aimed to analyze the epidemiological characteristics of mushroom poisoning and study the correlation between its cases and meteorological factors in Guizhou Province.MethodsWe collected data on mushroom poisoning and meteorological factors in Guizhou Province in 2023. A descriptive analysis was conducted on the epidemiological features of mushroom poisoning and meteorological factors. We used Spearman correlation analysis and the generalized additive model to examine the relationship between meteorological factors and the number of mushroom poisoning cases.ResultsIn 2023, mushroom poisoning cases in Guizhou Province were concentrated among individuals aged 20–59. Clinical symptoms were primarily gastrointestinal symptoms and occurrences peaked from June to October, mainly in the northeastern region of the province. Most incidents occurred in households. In 72 mushroom poisoning incidents where species were identified, 33 poisonous mushrooms were found. The number of mushroom poisoning cases in Guizhou Province was positively correlated with each meteorological factor(P < 0.05). The generalized additive model showed a significant nonlinear relationship between DGT, PRE, RHU, SSD, and the number of mushroom poisoning cases (P < 0.05). Interaction analysis showed that the risk of mushroom poisoning in Guizhou Province increased with the rising values of any two of these four meteorological factors.ConclusionMushroom poisoning incidents in Guizhou Province are characterized by high-risk groups, seasonality, and specific high-incidence regions and places. Public awareness for high-risk groups and early warnings for high-incidence regions and places should be strengthened every summer and fall. There is a correlation between meteorological factors and the number of mushroom poisoning cases, suggesting that these factors could serve as early warning indicators for the prevention and control of mushroom poisoning.