Mandatory Monitoring Research Articles

Killing Two Birds with One Stone: Mandatory Therapy and the Prevention of Sex Crime in France.

This paper considers the development of new clinical and medical practices in the early 2000s in France, after the adoption of legal reforms aiming at the prevention of sexual infractions and the protection of minors. The paper explains how the reform led to the creation of a new form of punishment for sexual offenders, l'obligation de soin (therapeutic obligation), which can be described as long-term mandatory therapeutic monitoring. This paper offers an analysis of the implementation of this measure from the standpoint of the specialized mental health care unit which were entrusted the mission of caring for the new group of convicted patients, i.e., patients sentenced to undergo mandatory therapy, after this legal reform. In the new regime these mandatory therapies created, clinicians are tasked to combine their conventional mission of care for the patient in the present, with the judicial mandate of detecting and preventing the patient's relapse qua recidivism in the future. Mobilizing ethnographic examples that evidence the way clinical care comes to encompass a penal mandate of long-term surveillance of convicted patients, I argue that the dual injunction of procuring care while preventing relapse-recidivism constrains the psychodynamic forms of clinical intervention deployed by French clinicians, realigns both psychiatric and clinical interventions along penal lines, and revives interest in some of the diagnostic categories and aims of criminal psychiatry which were important for the development of psychiatry in France.

Zoonotic potential of urban wildlife faeces, assessed through metabarcoding

Monitoring zoonoses in urban environments is of great relevance, where the incidence of certain pathogens may be higher and where population density makes the spread of any contagious disease more likely. In this study we applied a metabarcoding approach to study potentially zoonotic pathogens in faecal samples of 9 urban vertebrate species. We applied this methodology with two objectives. Firstly, to obtain information on potential pathogens present in the urban fauna of a large European city (Madrid, Spain) and to determine which are their main reservoirs. In addition, we tested for differences in the prevalence of these potential pathogens between urban and rural European rabbits, used as ubiquitous species. Additionally, based on the results obtained, we evaluated the effectiveness of metabarcoding as a tool for monitoring potential pathogen. Our results revealed the presence of potentially zoonotic bacterial genera in all studied host species, 10 of these genera with zoonotic species of mandatory monitoring in the European Union. Based on these results, urban birds (especially house sparrows and pigeons) and bats are the species posing the greatest potential risk, with Campylobacter and Listeria genera in birds and of Chlamydia and Vibrio cholerae in bats as most relevant pathogens. This information highlights the risk associated with fresh faeces from urban wildlife. In addition, we detected Campylobacter in >50 % of the urban rabbit samples, while we only detected it in 11 % of the rural rabbit samples. We found that urban rabbits have a higher prevalence of some pathogens relative to rural rabbits, which could indicate increased risk of pathogen transmission to humans. Finally, our results showed that metabarcoding can be an useful tool to quickly obtain a first screening of potentially zoonotic organisms, necessary information to target the monitoring efforts on the most relevant pathogens and host species.

The role of prescription opioid and cannabis supply policies on opioid overdose deaths.

Mandatory prescription drug monitoring programs and cannabis legalization have been hypothesized to reduce overdose deaths. We examined associations between prescription monitoring programs with access mandates ("must-query PDMPs"), legalization of medical and recreational cannabis supply, and opioid overdose deaths in United States counties in 2013-2020. Using data on overdose deaths from the National Vital Statistics System, we fit Bayesian spatiotemporal models to estimate risk differences and 95% credible intervals (CrI) in county-level opioid overdose deaths associated with enactment of these state policies. Must-query PDMPs were independently associated with on average 0.8 (95% CrI: 0.5, 1.0) additional opioid-involved overdose deaths per 100,000 person-years. Legal cannabis supply was not independently associated with opioid overdose deaths in this time period. Must-query PDMPs enacted in the presence of legal (medical or recreational) cannabis supply were associated with 0.7 (95% CrI: 0.4, 0.9) more opioid-involved deaths, relative to must-query PDMPs without any legal cannabis supply. In a time when overdoses are driven mostly by non-prescribed opioids, stricter opioid prescribing policies and more expansive cannabis legalization were not associated with reduced overdose death rates.

Severe neutropenia unrelated to clozapine in patients receiving clozapine.

Clozapine is known to cause agranulocytosis. Mandatory monitoring schemes are aimed at reducing the risk of agranulocytosis and of the consequences of agranulocytosis. All cases of agranulocytosis occurring in people prescribed clozapine are assumed to be caused by clozapine. In a previous study, we examined a cohort of patients listed on our hospital database as having had clozapine-induced agranulocytosis and applied specific criteria to identify those with confirmed clozapine-related, life-threatening agranulocytosis. In this study, we examine the cases not meeting these specific criteria. In the original study, 9 of 23 cases met the criteria for clozapine-induced, life-threatening agranulocytosis. Of the 13 remaining cases for whom data were available, 5 were probably caused by clozapine but were not life-threatening. Three cases were the result of concomitant cancer chemotherapy. Three were anomalous results probably related to measurement error. For the remaining two cases, the cause was not identified. Not all cases of agranulocytosis occurring in people taking clozapine are caused by clozapine. The widely used threshold criterion-based diagnosis overestimates the risk of agranulocytosis. True clozapine-related agranulocytosis is best identified by pattern-based criteria: rapid fall in neutrophil counts over around 2 weeks to below 0.5 × 109/L for two consecutive days (unless clozapine is stopped very early or granulocyte colony stimulating factor is given) where other possible causes (benign ethnic neutropenia, cancer chemotherapy) can be ruled out.

The role and importance of financial intelligence in identifying and tracing criminal assets

The paper examines the basic principles of improving efficiency and providing law enforcement officers, as well as authorized bodies, in whose management the seized property is transferred, with instructions on the legal grounds, procedural and tactical features of detection, search and seizure of property. It was determined that financial intelligence is a complex system aimed at detecting operations related to the legalization of proceeds obtained through crime. This system can act as a component of the pre-trial investigation in criminal proceedings related to the research. Asset search activities should include elements of economic and monetary intelligence. It has been established that in Ukraine, the State Financial Monitoring Service, subordinate to the Ministry of Finance of Ukraine, is entrusted with the functions of financial intelligence, which implements the state policy in the field of prevention and countermeasures against the legalization (laundering) of proceeds obtained through crime, the financing of terrorism, and the proliferation of weapons of mass destruction. It is argued that financial intelligence is not a function of the National Agency of Ukraine for detection, search and management of assets obtained from corruption and other crimes. In turn, the DSFM collects, processes and analyzes information on financial transactions subject to mandatory financial monitoring and other transactions related to money laundering. It was investigated that the bodies of foreign countries are similar: Financial Crimes Enforcement Network (FinCEN) - the US financial intelligence agency; Financial Transactions and Reports Analysis Center (FINTRAC), Canada's financial intelligence agency; Zentralstelle für Verdachtsanzeigen – German financial intelligence agency; TRACFIN – financial intelligence unit of the French Republic; The Inland Revenue Service NCIS/ECU is the UK's financial intelligence agency. Having analyzed the relevant legislation of ARMA and the State Financial Monitoring Service, we come to the conclusion that the terms "asset discovery" and "asset search" are explicitly defined at the legislative level only for ARMA. The profile legislation of the State Financial Monitoring Service does not reflect or explain the essence of these terms, however, in the course of implementing measures to prevent and counter the legalization (laundering) of proceeds obtained through crime, the State Financial Monitoring Service conducts financial investigations with the aim of finding information about the assets of questionable origin.

Time for a change to clozapine haematological monitoring.

This paper critiques the haematological monitoring guidelines for clozapine. It describes the history of clozapine, as well as the pathophysiology and epidemiology of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA). The paper appraises the extant literature on mandatory clozapine haematological monitoring. Contemporary Australian protocols for clozapine haematological monitoring are not consistent with the current evidence base. CIN and CIA are rare occurrences, and the associated risk of death is low. Potential modifications to existing guidelines include changing neutrophil thresholds for patients with benign ethnic neutropenia and reducing the frequency or removing haematological monitoring after two years of clozapine treatment.

Analysis of the state of the surface waters of the Pyasachnik dam

An ecological monitoring survey of the freshwater ecosystem of the Pyasachnik Dam was carried out in the period 2011-2016. The main indicators of surface water quality such as temperature, transparency, electrical conductivity, dissolved oxygen, N–NH4, N–NO2, N–NO3, orthophosphates P, total nitrogen, total phosphorus, and chlorophyll a content were monitored. Hereafter, the obtained results are discussed by years and seasons. The chemical status and ecological potential of the freshwater ecosystem were determined. The investigated surface waters are suitable for irrigation, but with a permanent mandatory monitoring. Keywords: ecological potential, irrigation, physicochemical monitoring, chemical status, chlorophyll

Effects of state opioid prescribing laws on rates of fatal crashes in the USA

BackgroundState opioid prescribing cap laws, mandatory prescription drug monitoring programme query or enrolment laws and pill mill laws have been implemented across US states to curb high-risk opioid prescribing. Previous...

Prevalence and antimicrobial susceptibility of Salmonella enteritidis and Salmonella typhimurium isolated from hen eggs and quail eggs in Karaj, Iran.

Different Salmonella serotypes are considered one of the most important food pathogens in the world. Poultry meat and eggs are the primary carriers of Salmonella in human populations. This study aimed to estimate the Salmonella enteritidis and Salmonella typhimurium contamination rates of retail hen and quail eggs in Karaj, Iran. Moreover, the antimicrobial resistance patterns of the strains were evaluated, and the efficiency of the standard culture method and multiplex polymerase chain reaction (m-PCR) were compared. In this descriptive cross-sectional study over 1 year (Jan-Dec 2022), 150 commercial and 150 backyard hen eggs and 300 commercial quail eggs, without cracks and fractures, were collected randomly from best selling groceries in Karaj city. All samples were examined for Salmonella contamination independently by standard culture and m-PCR approaches. A standard disc diffusion method was employed to assess the antimicrobial susceptibility of the strains against 18 antimicrobial agents. Out of 300 examined eggs, 2 S. enteritidis strains were isolated from the shell of backyard hen eggs. The same serotype was also detected in the contents of one of these two eggs. One S. typhimurium was isolated from the shell of a commercial hen egg. Overall, the Salmonella contamination of the shell and contents was 1% and 0.3%, respectively. Salmonella was not isolated from the eggshells or the contents of the quail eggs. There was complete agreement between the results of m-PCR and the standard culture methods. Among the 18 tested antibiotics, the highest resistance was recorded for colistin (100%), followed by nalidixic acid (75%). As most Salmonella spp. are associated with human food poisoning, continuous surveillance is required to effectively reduce the risk posed by contaminated poultry eggs. Furthermore, mandatory monitoring of antimicrobial use on Iranian poultry farms is recommended.

Contribution of Livestock Farming to Environmental Pollution in China

Purpose: The aim of the study was to examine contribution of livestock farming to environmental pollution in China. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study found that livestock farming in China significantly contributes to environmental pollution, posing substantial challenges to water, air, and soil quality. Intensive livestock operations, characterized by concentrated animal feeding operations (CAFOs), generate large quantities of animal waste containing nutrients and pathogens that contaminate water bodies. Additionally, livestock farming contributes to air pollution through emissions of ammonia and other pollutants, particularly in areas with intensive farming practices. Soil degradation and nutrient imbalance further exacerbate environmental degradation, with higher livestock densities associated with increased soil compaction and nutrient runoff. Unique Contribution to Theory, Practice and Policy: Tragedy of the Commons & Ecological Modernization Theory may be used to anchor future studies on contribution of livestock farming to environmental pollution in China. Promote the adoption of sustainable livestock management practices through capacity building, training, and extension services for farmers. Encourage the implementation of integrated farming systems that optimize resource use, minimize waste generation, and enhance environmental resilience. Strengthen regulatory frameworks and enforcement mechanisms to ensure compliance with environmental standards and promote responsible livestock production. Implement stringent measures to control water pollution from livestock waste, including mandatory wastewater treatment and monitoring programs.

Vitamin D and childhood disability: diseases of the nervous system

Child disability associated with diseases of the nervous system, the main cause of which is cerebral palsy (CP), is often accompanied by an insufficient level and high prevalence of vitamin D deficiency, but in our opinion, practicing physicians and health officials at all levels pay insufficient attention to this problem, therefore, this paper is devoted to the study of the influence of vitamin D on the disability of children resulting from diseases of the nervous system. We statistically investigated the association between the prevalence of vitamin D deficiency in municipalities of Khanty-Mansiysk Autonomous Okrug — Yugra and the number of cases of resulting childhood disability due to nervous system disease in 2021, using the anonymized results of 31,596 measurements of vitamin D levels in residents of the autonomous okrug, gratuitously provided to us by INVITRO-Ural LLC, whose staff the authors express their deep gratitude to. The calculations demonstrated the presence of a directly proportional relationship between the incidence of disability as a result of nervous system disease and the prevalence of severe vitamin D deficiency in the territory of Khanty-Mansi Autonomous Okrug — Yugra. The incidence of cerebral palsy is largely due to pregnancy abnormalities. Many researchers have associated the occurrence of cerebral palsy with preterm labor and low birth weight of the newborn with normal gestational age. The analysis indicates the great influence of vitamin D on the course and results of pregnancy, since pregnant women often have insufficient levels of vitamin D, which does not ensure full development of the fetus, which is accompanied by an increased incidence of various pathologies in the mother and child. Taking vitamin D supplements as prescribed by a doctor can be useful for pregnant women and children with cerebral palsy. The former need it to ensure the normal course and favorable outcome of pregnancy, and the latter — to increase bone mineral density and improve the body’s immune defense against a variety of diseases. To make recommendations on the amount of daily dosage and duration of vitamin D preparations, accurate knowledge of its initial level in the patient’s blood serum is required, which predetermines the need for mandatory monitoring of 25(OH)D levels in pregnant women and patients with cerebral palsy.

Clozapine clinical toolkit optimizes inpatient clozapine monitoring.

Clozapine is the most effective antipsychotic in the management of treatment-resistant schizophrenia; however, its use is challenging due to the risk of severe adverse effects. Despite the risks associated with clozapine, there is no mandatory monitoring in Canada beyond hematologic testing for agranulocytosis surveillance. This study focuses on the development, implementation, and evaluation of a clozapine clinical toolkit (CTK) targeted at optimizing inpatient clozapine use. A comprehensive literature review was conducted to identify clozapine best practices, experts were consulted, and a comprehensive clozapine CTK was developed and implemented at a large Canadian tertiary hospital in December 2018. To evaluate the CTK, a retrospective chart review was conducted to assess for change in guideline-concordant monitoring pre- and post- CTK implementation. Patients were included if they were > 18 years of age and received clozapine during inpatient admission. Results were analyzed using descriptive and inferential statistics. Among the charts reviewed, 185 and 113 admissions met the pre- and post-CTK inclusion criteria, respectively. Staff used the CTK in the care of 96% of clozapine patients post implementation, and its use resulted in improvements in guideline-concordant monitoring for agranulocytosis and myocarditis. Implementation of the clozapine CTK increased the concordance of clozapine monitoring with best practice recommendations. Future research is necessary to assess the impact of the CTK on clinical outcomes and patient satisfaction.

Association of state-level prescription drug monitoring program implementation with opioid prescribing transitions in primary care in Australia.

This study aimed to evaluate whether voluntary and mandatory prescription drug monitoring program (PDMP) use in Victoria, Australia, had an impact on prescribing behaviour, focusing on individual patients' prescribed opioid doses and transition to prescribing of nonmonitored medications. This was a retrospective cross-sectional study using routinely collected primary healthcare data. A 90-day moving average prescribed opioid dose in oral morphine equivalents was used to estimate opioid dosage. A Markov transition matrix was used to describe how patients prescribed medications transitioned between opioid dose groups and other nonopioid treatment options during 3 transition periods: transition between 2 control periods prior to PDMP implementation (T1 to T2); during the voluntary PDMP implementation (T2 to T3); and during mandatory PDMP implementation (T3 to T4). Among patients prescribed opioids in our study, we noted an increased probability of transitioning to not being prescribed opioids during the mandatory PDMP period (T3 to T4). This increase was attributed mainly to the ceasing of low-dose opioid prescribing. Membership in an opioid dose group remained relatively stable for most patients who were prescribed high opioid doses. For those who were only prescribed nonmonitored medications initially, the probability of being prescribed opioids increased during the mandatory PDMP when compared to other transition periods. The introduction of PDMP mandates appeared to have an impact on the prescribing for patients who were prescribed low-dose opioids, while its impact on individuals prescribed higher opioid doses was comparatively limited.

Increase in peg-asparaginase clearance as a predictor for inactivation in patients with acute lymphoblastic leukemia

Asparaginase is an essential component of acute lymphoblastic leukemia (ALL) therapy, yet its associated toxicities often lead to treatment discontinuation, increasing the risk of relapse. Hypersensitivity reactions include clinical allergies, silent inactivation, or allergy-like responses. We hypothesized that even moderate increases in asparaginase clearance are related to later inactivation. We therefore explored mandatory monitoring of asparaginase enzyme activity (AEA) in patients with ALL aged 1–45 years treated according to the ALLTogether pilot protocol in the Nordic and Baltic countries to relate mean AEA to inactivation, to build a pharmacokinetic model to better characterize the pharmacokinetics of peg-asparaginase and assess whether an increased clearance relates to subsequent inactivation. The study analyzed 1631 real-time AEA samples from 253 patients, identifying inactivation in 18.2% of the patients. This inactivation presented as mild allergy (28.3%), severe allergy (50.0%), or silent inactivation (21.7%). A pharmacokinetic transit compartment model was used to describe AEA-time profiles, revealing that 93% of patients with inactivation exhibited prior increased clearance, whereas 86% of patients without hypersensitivity maintained stable clearance throughout asparaginase treatment. These findings enable prediction of inactivation and options for either dose increments or a shift to alternative asparaginase formulations to optimize ALL treatment strategies.

Problems and perspectives for the use of exotic predators and parasitoids in biological control

The accidental introduction of alien organisms potentially harmful to agriculture can cause extensive damage to vegetable crops and fruit plants and is favoured by the global mobility of people, trade of goods and the ongoing climate change. The use of alien predators and parasitoids is well known in the agricultural field, where they are often used for biological control to protect fruit and horticultural plants. The management of invasive species is and will be one of the key issues for preserving biodiversity and the profitability of crops, the latter can now count on an effective, consolidated and lasting strategy: Integrated Pest Management (IPM). The legislation on this subject is complex and articulated and is continuously being updated. It allows for the development of specific skills in biological control and the availability to use quarantine chambers where it is possible to breed and study the behaviour of antagonists (predators and parasitoids), even exotic ones. If successful, their subsequent release to targeted biological control interventions of infestations of the IAS ‘Invasive Alien Species’ can be carried out. This contribution highlights the risk that such practices may involve and takes into account the following points: 1. The behaviour of an alien species can be very different in different contexts, being able to be a real IAS or not showing any character of invasiveness; 2. The behavior of an alien species can vary over time in the same context, diversifying and also expanding its trophic niche; 3. A good number of indigenous predators and parasitoids can over time adapt to new alien prey/hosts and could potentially be used for biological control. In future, biological control will be increasingly used given that EU funds reward and support this type of approach and the intentional introduction of alien natural predators and parasitoids into agroecosystems, although subject to strict protocols, cannot exclude spontaneous colonization by these last of natural environments with currently not assessable consequences on their biocoenosis. In conclusion, the rigorous risk analysis alone does not currently seem sufficient to exclude potential damage to local biodiversity, and programs for the release of exotic predators and parasitoids should be associated with mandatory monitoring of at least five years to verify the behaviour of these aliens in nature and their possible impact on ecosystems.

Unveiling the emergence of multidrug-resistant pathogens in exotic pets from France: a comprehensive study (2017-2019)

Aim: This study intends to assess the occurrence of multi-drug resistant (MDR) resistant pathogens among exotic pets from France (2017-2019). Methods: Isolates were identified using MALDI-TOF-MS. Antimicrobial susceptibility testing was conducted for 21 antimicrobials and was assayed by disk diffusion methods. Statistical analyses were carried out using GraphPad Prism® (version 9.4.1.). Results: Isolates (n = 2,100) recovered from samples of 10 small mammals (n = 1,555), 23 birds (n = 287), and 18 reptiles (n = 208) species were identified as Enterobacterales (n = 634), Pseudomonadaceae (n = 176), Pasteurellacea (n = 276), Staphylococcaceae (n = 563) , Streptococcaceae (n = 259), and Enterococcaceae (n = 186). Consistent high resistance rates were observed among diverse genera and/or species to beta-lactams, tetracyclines, and macrolides. Notably, a significant prevalence of MDR bacteria was identified, with 22.8% (n = 479/2,100, P < 0.05). Furthermore, 23.5% (P < 0.05) of these MDR bacteria displayed resistance to all tested antimicrobials: E. faecalis (n = 47/49; 95.0%), E. coli (n = 19/52; 36.5%), Klebsiella spp. (n = 12/32; 37.5%), S. epidermidis (n = 7/25; 28%), Streptococcus spp. (n = 6/68; 8.8%), Enterococcus spp. (n = 6/23; 26%), Staphylococcus spp. (n = 4/51; 7.8%), Lactococcus spp. (n = 4/8; 50%), Citrobacter spp. (n = 3/7; 42.8%), Raoultella spp. (n = 2/3; 66.6%), Serratia spp. (n = 1/9; 11.1%), Pasteurella spp. (n = 1/14; 7.1%), and S. xylosus (n = 1/28; 3.5%). Conclusions: This study emphasizes exotic pets as an emergent reservoir of MDR bacteria, focusing on E. faecalis as a potential route of transmission of MDR bacteria to humans, other animal species and environment. Urgent measures, including the establishment of mandatory monitoring for antimicrobial resistance (AMR) and the enforcement of restrictive antibiotic use policies in exotic pets, should be implemented to mitigate the risk of further spread and safeguard public and animal health.

An Overview of One Health Concept Focusing on Toxoplasmosis.

The "One Health" concept is a universal approach to sustainably balancing and optimizing the health of humans, animals, and ecosystems. This approach is based on the health of humans, domestic and wild animals, and plants in a wider environment in which self-renewable ecosystems exist, with essential characteristics of integration, unifying and holistic perspective. Toxoplasmosis, one of the most common zoonotic infections in both terrestrial and oceanic ecosystems in the world, is an ideal model disease for the "One Health" approach. Toxoplasmosis is a zoonotic disease caused by the obligate intracellular pathogen protozoan Toxoplasma gondii. In the life cycle of T. gondii, the definitive host is domestic cats and felines, and the intermediate hosts are all mammals (including humans), birds and reptiles. The infected cats have primary importance and play a crucial role in the contamination of habitats in the ecosystems with T. gondii oocysts. Thus, ecosystems with domestic cats and stray cats are contaminated with cat feces infected with T. gondii oocytes. T. gondii positivity has been scientifically demonstrated in all warm-blooded animals in terrestrial and aquatic habitats. The disease causes deaths and abortions in farm animals, resulting in great economic losses. However, the disease causes great problems in humans, especially pregnant women. During pregnancy, it may have effects such as congenital infections, lesions in the eye and brain of the fetus, premature birth, intrauterine growth retardation, fever, pneumonia, thrombocytopenia, ocular lesions, encephalitis, and abortion. The mechanism of death and abortion of the fetus in a pregnant woman infected with T. gondii occurs as a result of complete disruption of the maternal immune mechanism. The struggle against toxoplasmosis requires the universal collaboration and coordination of the World Organization for Animal Health, the World Health Organization and the World Food Organization in the "One Health" concept and integrative approaches of all responsible disciplines. Establishing universal environmental safety with the prevention and control of toxoplasmosis requires the annihilation of the feces of the infected cats using suitable techniques firstly. Then routinely, the monitoring and treatment of T. gondii positivity in cats, avoiding contact with contaminated foods and materials, and development of modern treatment and vaccine options. Particularly, mandatory monitoring or screening of T. gondii positivity during the pregnancy period in humans should be done. It would be beneficial to replace the French model, especially in the monitoring of disease in humans. In this article, the ecology of toxoplasmosis was reviewed at the base of the "One Health" concept.

Risk reduction effects of introducing an automated painting process

As a consequence of the expansion of occupations, the emergence of new businesses and new forms of occupation, the risks to workers have increased. The world of work, the modern manufacturing industry, is full of dangers and hazards in the form of accidents at work and occupational diseases. The boom in production and the economy, combined with ever-increasing expectations of work, has led to an increase in the number of accidents at work, including occupational diseases and fatalities. Lack of knowledge of the pathogenic factors and lack of technical or personal protection are still the main reasons for the occurrence and emergence of cases of increased exposure. In the case of work with certain hazardous substances, mandatory biological monitoring is often not carried out, although early detection of cases and appropriate measures by the employer could lead to a reduction or elimination of exposure. Our work has investigated the health effects of workers exposed to chemical agents and the options for removing workers exposed to these agents from hazardous work environments. Our aim is to investigate the health effects of chemical agents on humans and the possibilities of their induction in order to reduce or provide optimal conditions for safe and healthy working. During the study, particular attention was paid to the investigation of substitutes and the possibility of automation.

Retrospective Analysis of Spontaneous Reports of Fatal Adverse Reactions Associated with Lidocaine

SCIENTIFIC RELEVANCE. Pain and pain relief are among the most important problems that arise during medical procedures. Lidocaine is used not only as an anaesthetic during interventions but also as a diluent for other medicinal products. Analysis of adverse drug reactions (ADRs) associated with lidocaine contributes to studying lidocaine toxicity and, as a result, developing measures to reduce side effects.AIM. The authors aimed to conduct a retrospective analysis of spontaneous reports of fatal ADRs associated with lidocaine.MATERIALS AND METHODS. This study analysed spontaneous ADR reports of fatal outcomes associated with lidocaine submitted to the federal ADR database in the Automated Information System of the Federal Service for Surveillance in Healthcare of the Russian Federation (Pharmacovigilance, versions 1.0 and 2.0) from 1 January 2008 to 31 December 2020.RESULTS. The ADR reports included 102 fatal outcomes associated with lidocaine. Most often, lidocaine was prescribed as a local anaesthetic or as a diluent for antibacterials. Studying the administered lidocaine doses, the authors identified several overdose cases. Most life-threatening conditions were due to hypersensitivity reactions of anaphylactic shock (54 cases, 52.9%). Lidocaine administration was accompanied by loss of consciousness, respiratory failure, and cardiac arrest in 10 cases (9.8%). Convulsions were a significant clinical sign in 9 cases (8.8%).CONCLUSIONS. Awareness of the risks of systemic toxic effects of local anaesthetics, including lidocaine, necessitates the practical implementation of certain safety measures, such as allergy skin tests before administration and mandatory monitoring of doses and patients’ well-being after administration.

Same day discharge after interventional electrophysiology procedures, first German experience

Abstract Background and purpose In most European countries, the current postprocedural gold standard following electrophysiological (EP) interventions implies the overnight monitoring of the patients in the hospital. Due to limited healthcare capacities and an increasing safety profile of ablation procedures, the mandatory overnight monitoring is under debate. Same day discharge protocol (SDD) ablation might be a safe and efficient alternative. We present the first German experience on SDD for EP interventions. Methods Patients receiving interventional EP procedures with a maximum of two VAs were discharged on the day of procedure, after the hemostasis and ambulation were proven. The VA hemostasis was achieved either by using a vascular closure system (VCS) or by a figure-of-eight suture followed by compressive bandage application. All patients were scheduled for a medical visit the day after procedure for groin examination and suture removal. Results A total of 12 patients (25% females, median age 64 (57.3, 66.8) years, median BMI 30.5 (22.3, 33.7) Kg/m2) undergoing EP procedures followed the SDD protocol in our center. All patients had an atrial fibrillation (AF) diagnosis, 66.7% of them paroxysmal. Five (45.5%) patients had a CHA2DS2VASc score of 1. A total of 4 (33.3%) patients presented arterial hypertension, 3 (25%) diabetes mellitus, 1 a history of stroke, 1 of myocardial infarction and 1 had chronic kidney disease and kidney transplantation. Eleven (91.7%) patients were under oral anticoagulation. The most common procedure was AF ablation, in 10 (83.3%) patients, while 1 (8.3%) patient underwent cavotricuspid isthmus (CTI) ablation and 1 (8.3%) a left atrial appendage closure procedure. In 10 (72.7%) AF ablations the energy source was cryoenergy, in 1 laserenergy and in 1 electroporation. The CTI ablation was performed by means of radiofrequency. A VCS was used in 7 (58.3%) patients. Six of these patients received 2 VCSs, while the patient with PFA based ablation had a single vascular access, thus only one VCS. The procedure was reported successful in all cases, and no intraprocedural complication occurred. During the next day visit, a groin hematoma has reported in 2 (16.7%) patients, no one requiring further therapeutical measures or hospitalization. All the other patients had no puncture related complications. The median FU time was 46.5 (26, 90.3) days. During FU only one patient had an unplanned ambulatory visit due to flecainide intolerance. Readmission during FU was reported in only 2 patients, none of them procedure related. Conclusions In selected patients undergoing EP procedures SDD seems to be safe and feasible. This approach increases healthcare capabilities, patients' comfort and reduces the cost of medical care.