Unintentional Ingestion Research Articles

The trajectory of serum salicylate concentrations after ingestion of medicinal oil containing methyl salicylate

Introduction The toxicokinetics of methyl salicylate after unintentional or intentional ingestion of medicinal oil containing methyl salicylate has not been well studied. We aimed to characterize the trajectory of serum salicylate concentrations and to evaluate factors associated with the peak serum salicylate concentration and the time from ingestion to peak concentration. Methods This was a retrospective cohort study of consecutive patients reported to the Hong Kong Poison Control Centre for laboratory-confirmed methyl salicylate poisoning by all local public emergency departments between 1 July 2008 and 30 June 2023. We analyzed cases with at least three serum salicylate concentrations. Multivariable generalized linear regression was used to identify factors significantly associated with the peak serum concentration and the time from ingestion to peak concentration. Results We included 41 patients (median age 81.0 years; 32 women and nine men). The median time from ingestion to the first peak serum salicylate concentration was 5.6 h (IQR: 3.2–10.8 h). Multiple regression showed that gastric aspiration (adjusted regression coefficient [β] − 2.50; 95% CI: −3.93 to −1.08; P = 0.001) and single-dose activated charcoal (adjusted β − 1.22; 95% CI: −2.02 to −0.42; P = 0.003) were significantly associated with a lower peak concentration, after adjusting for patient age, sex, exposure due to intentional self-harm, reported ingested dose, time from ingestion to emergency department presentation, vomiting, concurrent use of aspirin (acetylsalicylic acid) and other medications that affect gastric emptying or gastric acid secretion, blood pH, serum albumin concentration, and creatinine clearance. Discussion The serum salicylate concentration did not peak as quickly as generally believed, highlighting the importance of continued monitoring. Gastric aspiration and single-dose activated charcoal may help reduce gastrointestinal absorption, but their impact on clinical outcomes remains unclear. Conclusions Given the median time of 5.6 h (IQR: 3.2–10.8 h) from ingestion to the peak salicylate concentration, gastric aspiration and single-dose activated charcoal can be considered in patients up to a few hours after medicinal oil ingestion when the airway is protected.

Evaluating Bias of Child Maltreatment Referrals in Encounters for Unintentional Ingestions

BackgroundUnintentional ingestions commonly result in presentation to the pediatric emergency department (PED). No standardized recommendations exist regarding when to call Child Protective Services (CPS) for unintentional ingestions, which allows for the possibility of biased decision-making. ObjectiveIdentify patient and visit level characteristics associated with CPS referral status in unintentional ingestion encounters. Participantsand Setting: Retrospective cross-sectional study of children ≤6 years old presenting with unintentional ingestion to a metropolitan PED from 2015 to 2021. MethodsICD-10-CM codes were used to identify unintentional ingestion visits in the electronic health record. CPS referral was determined by manual chart review. Bivariable and multivariable logistic regression models identified patient and visit level characteristics associated with CPS referral. Socioeconomic status (SES) was classified based on zip code, the Child Opportunity Index data, and insurance. ResultsOf 3,836 charts reviewed, 808 met inclusion criteria. CPS referrals were made in 109 (13.5%) visits. Compared to non-Hispanic white patients, non-Hispanic Black patients had 7.37 (95% CI:1.38, 39.26) higher adjusted odds of being referred to CPS after adjusting for triage level, age, and ingestion type. Patients in the Lowest SES group had a 3.01 (95% CI:1.42, 6.40) higher adjusted odds when compared to the Middle/Highest SES group. ConclusionThis study found that CPS referrals in unintentional ingestions occur more often in those identifying as non-Hispanic Black and in those in the Lowest SES group, suggesting clinician bias may impact the decision regarding referrals. To mitigate subjective decision-making, we propose creating standardized, objective CPS referral criteria for unintentional ingestions.

An outbreak of Galerina sulciceps-like (Galerina cf. sulciceps) mushroom poisoning

Objective Amatoxin-containing mushroom poisoning is a significant threat to public health worldwide. We report a mass poisoning of Galerina sulciceps-like mushrooms (Galerina cf. sulciceps) in Luzhou, Sichuan Province, China, aiming to offer insights for future prevention and treatment strategies. Methods We performed a retrospective survey of mass mushroom poisoning patients admitted to our hospital. The demographic data, clinical presentations, laboratory findings, therapeutic measures and prognostic information were collected and analyzed. We used the 2020 Chinese consensus on the clinical diagnosis and treatment of amatoxin-containing mushroom poisoning to assess the severity of poisoning. Mushrooms were examined through morphological analysis, molecular biology identification, and toxin detection. Results Our patient cohort consisted of nine males and six females, with mean (±SD) age of 34.9 ± 13.0 years. Gastrointestinal symptoms were the first to manifest, with mean (±SD) latency period of 13.4 ± 3.9 h. The majority of patients (86.7%) experienced nausea, vomiting, and diarrhea. Liver dysfunction was noted in 66.7% of patients, and thrombocytopenia was present in 26.7% of patients. In terms of the severity of poisoning, there were 10 mild cases and 5 severe cases. The mushrooms were provisionally labeled as Galerina cf. sulciceps, containing the toxins α-amanitin, β-amanitin, and γ-amanitin. All patients eventually recovered. Discussion We report what appears to be a new type of mushroom that is morphologically and phylogenetically similar to the known Galerina sulciceps, but further study is required to determine if it represents a distinct species. Conclusion This poisoning event was caused by unintentional ingestion of Galerina cf. sulciceps, an amatoxin-containing mushroom. Early symptoms are primarily gastrointestinal, with acute liver damage and coagulopathy being the main toxic effects. Thrombocytopenia is also prominent, particularly in severe cases. Accurate assessment and prompt, individualized, and intensive treatment are crucial for managing patients with acute Galerina cf. sulciceps poisoning effectively.

Guide to extraluminal fish bone retrieval with serial computed tomography scans: a case series

BackgroundFish bone ingestion is commonly encountered in emergency department. It poses a diagnostic and therapeutic challenge particularly when it migrates extraluminally, necessitating a comprehensive and multidisciplinary approach for successful management.Case presentationHere we reported four cases of extraluminal fish bone. The first patient was a 68-year-old Chinese man who had odynophagia shortly after a meal involving fish. The second was a 50-year-old Iban man who reported a sharp throat pain after consuming fish 1 day prior. The third patient was a 55-year-old Malay woman who developed throat pain and odynophagia after consuming fish 1 day earlier. The fourth patient, a 70 year-old Iban man, presented late with odynophagia, neck pain, swelling, and fever 1 week after fish bone ingestion. These unintentional fish bone ingestions faced challenges and required repeat computed tomography scans using multiplanar reconstruction in guiding the surgical removal of the fish bone.ConclusionWe underscore the significance of multiplanar reconstruction in pinpointing the fish bone’s location, demonstrating the migratory route, and devising an accurate surgical plan.

Acute poisoning in children in Chengdu, China: a retrospective study (2019–2022)

ObjectiveTo analyze the characteristics of children with acute poisoning admitted to emergency departments in the southwestern region of China.MethodsData were retrospectively collected from the hospital information system in Chengdu, West China Second Hospital from January 2019 to December 2022 and the frequency and substance of pediatric poisoning, clinical management and outcome were described in this study.ResultsA total of 2036 cases with acute poisoning aged from 0–14 years were included, of these, 272 were hospitalized, with 40 admitted to the pediatric intensive care unit. The incidence was slightly higher in boys than girls (51.2% vs. 48.8%). The most common route of poisoning was the digestive system (99.3%), and the majority were accidental poisonings (92.7%). Medications were the most common toxic substances (62.1%), followed by pesticides (12.4%) and household cleaners (8.8%). The proportion of toxic substances varied among different age groups, with household cleaners being the most common in infants, and pesticides in other age groups, excluding medications.ConclusionChildren in early childhood accounted for most acute poisoning cases, mostly due to unintentional ingestion of a single substance. Female adolescents were the most common patients intentionally ingested toxic substances, mainly psychotropic drugs.

Pediatric injuries and poisonings associated with detergent packets: results from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), 2011–2023

BackgroundDetergent packets are common household products; however, they pose a risk of injuries and poisonings, especially among children. This study examined the epidemiological characteristics of pediatric injuries and poisonings related to all types of detergent packets in Canada using emergency department (ED) data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database.MethodsThe CHIRPP database was searched for ED visit records for injuries and poisonings related to all types of detergent packets between April 1, 2011 and October 12, 2023 (N = 2,021,814) using variable codes and narratives. Data for individuals aged 17 years and younger were analyzed descriptively. Temporal trends in the number of detergent packet-related injuries and poisonings per 100,000 CHIRPP cases were assessed using Joinpoint regression and annual percent change (APC). A proportion ratio and 95% confidence intervals (CI) were calculated to compare the proportion of detergent packet-related cases in CHIRPP during two 34-months periods, pre-COVID-19 pandemic and after the beginning of the pandemic.ResultsThere were 904 detergent packet-related cases among children and youth aged 17 years and younger identified in CHIRPP between April 1, 2011 and October 12, 2023, representing 59.9 cases per 100,000 CHIRPP cases. The majority (86.5%) of cases were among children aged 4 years and younger. Poisonings (58.8%) and eye injuries (30.6%) were the most frequent primary diagnoses. Unintentional ingestion (56.9%) and squeezing/breaking a detergent packet (32.3%) were the most frequent exposure mechanisms. Sixty-five patients (7.2%) were admitted to hospital. The number of detergent packet-related cases per 100,000 CHIRPP cases increased by 5.0% (95% CI 0.8, 10.2) annually between 2012 and 2022. The number of detergent packet-related poisonings per 100,000 CHIRPP cases decreased by 15.3% (95% CI − 22.3, − 10.6) annually between 2015 and 2022, whereas eye injuries showed an average annual percent increase of 16.6% (95% CI 11.2, 23.0) between 2012 and 2022. The proportion of detergent packet-related cases in CHIRPP after the beginning of the pandemic (79.9/100,000 CHIRPP cases) was 1.43 (95% CI 1.20, 1.71) times greater than pre-pandemic (55.7/100,000 CHIRPP cases).ConclusionsDetergent packet-related injuries and poisonings are a persisting issue. Continued surveillance and prevention efforts are needed to reduce detergent packet-related injuries and poisonings in Canada, particularly among children and youth.

Cannabis Legalization and Resource Use for Ingestions by Young Children.

In conjunction with widening legalization, there has been a rapid rise in unintentional cannabis ingestions in young children. We sought to determine if the legal status of recreational cannabis was associated with resource use in young children with cannabis poisoning. This retrospective cross-sectional study of the Pediatric Health Information System included emergency department encounters between January 2016 and April 2023 for children <6 years of age with a diagnosis indicating cannabis ingestion. The primary exposure was recreational cannabis legalization status in the state in which the encounter occurred. We used logistic regression models to determine the association of recreational cannabis legality with resource utilization outcomes, adjusting for demographic covariates. We included 3649 children from 47 hospitals; 29% of encounters occurred in places in which recreational cannabis was legal. Compared with environments in which recreational cannabis was illegal, cannabis-legal locations had lower uses of advanced neuroimaging (24% vs 35%; adjusted odds ratio [aOR], 0.65; 95% confidence interval [CI]: 0.55-0.77), lumbar puncture (1.6% vs 3.8%; aOR, 0.42; 95% CI: 0.24-0.70), ICU admission (7.9% vs 11%; aOR, 0.71; 95% CI: 0.54-0.93), and mechanical ventilation (0.8% vs 2.9%; aOR, 0.30; 95% CI: 0.14-0.58). Urine testing was more common in places in which recreational cannabis was legal (71% vs 58%; aOR, 1.87; 95% CI: 1.59-2.20). State-level legalization of recreational cannabis was associated with a significant decrease in the utilization of advanced medical resources in cases of cannabis intoxication in children. These findings suggest the need for a focus on policies and procedures to minimize invasive testing in cases of cannabis intoxication in children.

Concentrations and probable health risks of potentially toxic metals (Pb, Cd and Cr) in some Nigerian lipstick products

BackgroundLipstick is one of the widely used cosmetic items that are produced from both natural and processed materials and they are one of the sources of metals and metalloids released among the users. This study measured concentrations of Pb, Cd and Cr in some brands of Nigerian lipstick products and assessed their probable health risks to the users. MethodsA total of twenty (L1 - L20) brands of lipstick products were purchased from the central cosmetic stores and the samples were prepared, digested and concentrations of Pb, Cd and Cr were determined using Atomic Absorption Spectrometry (AAS). The probable health risk was assessed via average daily dose (ADD) by ingestion route, hazard quotient (HQ), hazard index (HI), cancer risks (CR), and relative intake index (RII). ResultsThe ranges of concentrations of Pb, Cd and Cr were 5.6 - 25.1, 2.5 - 21.5 and 5.0 - 61.7 μg g−1, respectively. The ranges of ADD values of Pb, Cr and Cd were 1.2 × 10−3 - 5.7 × 10−3; 1.3 × 10−3 - 5.7 × 10−3 and 5.1 × 10−3 - 1.4 × 10−3 µg day−1, respectively. Among the samples Cr had HQ values 1.3 to 9.6. The HQ values of Cd for L2, L6, L12 and L14 ranges between 1.1 and 1.5. Then HQ values of Pb for L1 -L20 were 1.0 - 4.1. The HI values of Pb, Cr and Cd in each lipstick brands range from 2.8 to 12.5, indicating a non-carcinogenic health risk. The CR values for Cr and Cd are from 6.6 × 10−4 to 6.9 × 10−4 and from 2.0 × 10−2 to 2.5 × 10−2, respectively and they were within the acceptable limit value of 1.0 × 10−4. The RII of Pb, Cd and Cr were 4.50 - 20.1, 2.0 – 19.2 and 1.9 – 23.0 %, respectively. ConclusionAll the health indices indicated non-carcinogenic health risks. The continuous exposure and unintentional ingestion of such lipstick products can pose high risks to the users due to bioaccumulation of Pb, Cd and Cr which may lead to negative health conditions.

Is EGD Needed in all Patients after Suicidal or Exploratory Caustic Ingestions?

Caustic ingestions are relatively uncommon, but remain a significant source of morbidity. Patients with caustic injury often undergo an urgent EGD, although it is not clear if an EGD is routinely needed in an asymptomatic patient. The study has two primary objectives; 1) to determine the utility of routine EGD in asymptomatic suicidal caustic ingestions; 2) to determine if asymptomatic unintentional acidic ingestions can be managed with observation alone, similar to basic ingestions. This retrospective study, which took place at 14 hospitals in three countries evaluated all patients who presented with a caustic ingestion between 2014-2020. The presence of symptoms and esophageal injury, demographic information, pH of ingested substance, reason for the ingestion, and outcome were recorded. 409 patients were identified; 203 (46.9%) were male. The median (IQR) age was 18 (4-31) years; overall range 10months to 78years. Suicidal ingestions accounted for 155 (37.9%) of cases. Dysphagia or dysphonia were more likely in those with significant esophageal injury compared to those without (59.3% vs. 12.6% respectively; OR 10.1; 95% CI 4.43-23.1). Among 27 patients with significant esophageal injury, 48% were found in suicidal patients, compared with 51.9% in non-suicidal patients (p = NS). On multivariate regression, there was no difference in the rate of significant esophageal injury among suicidal vs. non suicidal patients (aOR 1.55; p = 0.45, 95% CI 0.45-5.33). Most ingestions involved basic substances (332/409; 81.2%). Unknown or mixed ingestions accounted for 25 (6.11%) of the ingestions. Significant esophageal burns were found in 6/52 (11.5%) of acid ingestions, compared with 21/332 (6.3%) of basic ingestions. Of the 42 cases of acidic ingestions without dysphagia or odynophagia, 2 (4.8%; 0.58-16.1%) had significant esophageal burns, compared with 9 (3.2%; 95% CI 1.4-5.9%) of the 284 basic ingestions; p = 0.64). On multivariate logistic regression, patients with acidic ingestions were not more likely to experience a significant burn (aOR 1.7; p = 0.11, 95% CI 0.9-3.1) compared to those with basic ingestions. No patient with significant esophageal burns was asymptomatic. In this study, there was no statistical differences in the rates of significant burns between acidic and basic caustic ingestions. There were no significant esophageal injuries noted among asymptomatic patients.

Risk assessment of di-(2-ethylhexyl) phthalate plus a high-fat diet in the rat kidney

Di-(2-ethylhexyl) phthalate (DEHP) is used in food packaging and medical products, resulting in unintentional human ingestion. Concurrently, a high fat (HF)-oriented diet is very popular for many people worldwide. Here we investigated the regulatory role of renin-angiotensin system in kidney dysfunction. The HF diet-fed rats were fed a HF diet plus different doses of 10, 100 and 300 mg/kg bw DEHP for 35 days by gavage. Serum lipid contents and protein activities of renin-angiotensin system (RAS) components were measured using biochemical methods and ELISA; key metabolic genes and proteins of the kidney were determined by RT-PCR and western blotting techniques. Kidney morphology was examined through hematoxylin-eosin (HE) staining. Kidney weight to body weight ratio and mRNA expression of kidney damage markers were significantly increased following DEHP plus HF administration, which corresponded histologically with glomerular basement membrane thickening and glomerular swelling. Furthermore, DEHP treatment plus a HF diet induced dyslipidemia, accompanied by increased levels of renin-angiotensin system components, such as ACE protein, MAS-1 protein, serum renin and aldosterone. In addition, mRNA expression levels of pro-inflammatory cytokines were significantly upregulated in the kidneys. Pearson correlation analysis revealed that higher kidney ACE expression and ACE/ACE-2 ratio were positively associated with TG, TC and LDL-C levels. These data suggest that combined exposure to DEHP exposure plus a HF diet feeding may induce renal damage through overactivation of RAS.

Risk of Gluten Cross-Contamination Due to Food Handling Practices: A Mini-Review.

Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, affecting 1.4% of the world population. CD induces an inflammatory reaction that compromises small intestine villi, leading to nutrient malabsorption, and gastro and extraintestinal manifestations. Although other treatment approaches are being studied, adherence to a gluten-free diet (GFD) is the only effective intervention to date. Despite this, about 50% of patients experience persistent inflammation, often associated with unintentional gluten ingestion through contaminated food. There are regulations for labeling gluten-free foods which specify a limit of 20 mg/kg (20 ppm). The risks of gluten cross-contamination above that level are present throughout the whole food production chain, emphasizing the need for caution. This review explores studies that tested different procedures regarding the shared production of gluten-containing and gluten-free food, including the use of shared equipment and utensils. A literature review covering PubMed, Scielo, Web of Science, VHL and Scopus identified five relevant studies. The results indicate that shared environments and equipment may not significantly increase gluten cross-contamination if appropriate protocols are followed. Simultaneous cooking of gluten-containing and gluten-free pizzas in shared ovens has demonstrated a low risk of contamination. In general, shared kitchen utensils and equipment (spoon, ladle, colander, knife, fryer, toaster) in controlled experiments did not lead to significant contamination of samples. On the other hand, cooking gluten-free and gluten-containing pasta in shared water resulted in gluten levels above the established limit of 20 ppm. However, rinsing the pasta under running water for a few seconds was enough to reduce the gluten content of the samples to less than 20 ppm.

Using Quantitative Microbial Risk Assessment (QMRA) of SARS-CoV-2 to understand possible exposure to health risks in selected wastewater treatment plants located in the Eastern region of South Africa

In the past two years, Covid-19 has emerged as the most severe and pressing public health issue, causing a great deal of damage to societal and economic welfare, as well as causing illness and mortality. The operators in wastewater treatment plants (WWTPs), particularly those employed in rural communities, appear to often exhibit a lack of adherence to proper safety protocols by not utilizing sufficient protective equipment while handling unprocessed sewage samples throughout the different phases of wastewater treatment and disposal. This study aimed at examining the potential health risk of infection among WWTP operators, as a result of unintentional ingestion of wastewater during routine duties in facilities that receive influent containing Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) from various areas. This study examined the prevalence of SARS-CoV-2 in grab samples of untreated wastewater samples using the real-time quantitative polymerase chain reaction (RT-qPCR) technique and quantitative microbial risk assessment (QMRA) model was employed on three probable exposure of SARS-CoV-2 scenarios that are expressed as moderate, aggressive and extreme (2 mL, 10 mL, 20 mL) to evaluate the probability of infection to WWTP workers based on the 6 h that the workers spent in WWTPs performing their daily activities which exposed them to potential health risk of various pathogens. At the highest SARS-CoV-2 genome of 266.23 × 102 gc/mL, the findings indicated that there was no statistically significant difference in the probability of infections with respect to seasonal differences because the P(i) value was greater than 0.05 (p > 0.05). Overall, P(i) was highly significant across all volumetric scenarios in the study with p value that was p < 0.001. The probability of getting infected during the different seasons is assumed to be low since there was no statistically difference in P(i) with respect to season however it can be assumed that there is a high chance of getting infected regardless of volumetric intake. Our study suggests that the risk of accidental occupational exposure to SARS-CoV-2 in raw wastewater is negligible to workers whereby workers would perform their daily activities without wearing protective gear. Nevertheless, the importance and work of WWTPs by workers should not be overlooked. Regardless of the situation, it is widely recognized that residential wastewater poses a potential risk of infection due to the presence of several enteric pathogens, therefore, it is crucial to ensure that those who are occupationally exposed to untreated wastewater are well equipped with suitable personal protective equipment (PPE).

Detection of Anatoxins in Human Urine by Liquid Chromatography Triple Quadrupole Mass Spectrometry and ELISA.

Harmful cyanobacterial blooms are becoming more common and persistent around the world. When in bloom, various cyanobacterial strains can produce anatoxins in high concentrations, which, unlike other cyanobacterial toxins, may be present in clear water. Potential human and animal exposures to anatoxins occur mainly through unintentional ingestion of contaminated algal mats and water. To address this public health threat, we developed and validated an LC-MS/MS method to detect anatoxins in human urine to confirm exposures. Pooled urine was fortified with anatoxin-a and dihydroanatoxin at concentrations from 10.0 to 500 ng/mL to create calibrators and quality control samples. Samples were diluted with isotopically labeled anatoxin and solvent prior to LC-MS/MS analysis. This method can accurately quantitate anatoxin-a with inter- and intraday accuracies ranging from 98.5 to 103% and relative standard deviations < 15%, which is within analytical guidelines for mass spectrometry methods. Additionally, this method qualitatively detects a common degradation product of anatoxin, dihydroanatoxin, above 10 ng/mL. We also evaluated a commercial anatoxin-a ELISA kit for potential diagnostic use; however, numerous false positives were detected from unexposed individual human urine samples. In conclusion, we have developed a method to detect anatoxins precisely and accurately in urine samples, addressing a public health area of concern, which can be applied to future exposure events.

Disparities in Child Welfare Referrals for Patients Seen in a Pediatric Emergency Department for Unintentional Ingestions

ObjectiveTo examine the characteristics of patients visiting the pediatric emergency department (PED) for unintentional ingestions and associations between patient race and ethnicity in referrals to Child Protective Services (CPS) for supervisory neglect. MethodsWe conducted a cross-sectional analysis of children <12 years old who presented to the PED between October 2015 and December 2020 for an unintentional ingestion. Patients were identified by searching the electronic health record for diagnosis codes corresponding to unintentional ingestions. Patient demographics, ingestion type, disposition, and referrals to CPS were abstracted by manual chart review. Logistic regression models were used to evaluate associations between patient demographics and visit characteristics with referral to CPS. ResultsWe identified 129 PED encounters for unintentional ingestions that were included for analysis. Overall, 22 patients (17.1%) were referred to CPS for neglect. In the univariate analysis, both ingestion of an illicit drug and arrival to the PED by ambulance were associated with a higher odds of referral to CPS. In the multivariable model adjusted for parent language, ingestion type, and mode of arrival to the PED, Hispanic patients had higher odds of referral to CPS than White patients (adjusted odds ratio (aOR) = 17.2, 95% confidence intervals [1.8–162.3], P = .03). There was not a statistically significant association between Black race and referral to CPS. ConclusionsReferrals to CPS from the PED after unintentional ingestions are common and disproportionally involve Hispanic patients. More research is needed to promote equitable child maltreatment reporting for children presenting to the PED following unintentional ingestions.

Stomach Foreign Body: A Retrospective Study with a Review

Foreign bodies in the stomach may be accidental or voluntary swallowing. Most foreign bodies are due to unintentional ingestion except in insane people or drug peddlers who may be voluntary. Most of the time, coins are accidentally ingested by children. A rare phenomenon is accidental ingestion of a size 16 to 20 cm in length (toothbrush) foreign body in a sane person. Oesophageal foreign bodies are not as risky as airway foreign bodies. These foreign bodies can obstruct and are located at the oesophagus cricopharynx constriction, the crossover of the aortic arch at the mid-oesophagus, and the lower end. After reaching the stomach, most ingested foreign bodies less than 6 cm will pass uneventfully through the gastrointestinal tract, as in 10 patients who consumed one/two rupee coins. Nevertheless, long and rigid foreign bodies like toothbrushes can result in gastrointestinal impaction, perforation and bleeding. Moreover, there have been a few case reports of spontaneous passage of a toothbrush, and promptly removing such ingested foreign objects is recommended before complications develop. Treatment option remains controversial considering the waiting policy or intervention, either endoscopic or surgical. This study describes 11 patients, 10 cases of coin ingestion and one case of the swallowed toothbrush. Ten cases of coin ingestion were managed conservatively. Upper midline laparotomy was done to remove the toothbrush as removal via flexible endoscopy failed. A swallowed toothbrush is a special clinical challenge. Early retrieval of the toothbrush is critical for reducing morbidity.

Risk Behind the Glamour: Lipstick and its Health Impacts

Lipstick has been a beloved cosmetic for centuries, enhancing the beauty of women worldwide. Lipstick has long been a symbol of beauty and femininity, but beneath its glamorous facade lies potential health risks that deserve attention. This mini review aims to provide a comphrensive overview of the health impacts associated with lipstick use, shedding light on the potential dangers of certain ingredients and the need for consumer awareness. One of the primary concerns surrounding lipstick is the presence of heavy metals. Studies have shown that many lipsticks contain trace amounts of lead, cadmium, and other heavy metals, which can be absorbed through the skin and potentially harm the body overtime. These metals have been linked to various health issues, including reproductive problems and neurotoxicity. Furthermore, the prolonged use of lipstick can lead to unintentional ingestion of harmful metals, posing additional risks. In addition to heavy metals, certain lipsticks may contain parbens, a type of preservative commonly used in cosmetics. Parabens have been associated with hormonal disruption and have raised concerns about their potential links to breast cancer. While the evidence is not conclusive, the presence of parabens in lipsticks warrants further investigation and caution use. However, it’s not all doom and gloom. Many reputable cosmetic brands are taking steps to prioritize safety and offer lipstick options that are free from heavy metals and harmful chemicals. These brands employ rigorous testing and adhere to stricter regulations to ensure the safety of their products. Consumers can make more informed choices by opting for lipstick brands that prioritize safety and transparency in their ingredients lists. In conclusion, while lipstick may enhance our appearance and boost confidence, it’s crucial to be aware of the potential health impacts associated with its use. The presence of heavy metals and potentially harmful ingredients should not be overlooked. By staying informed, choosing safer lipstick options, and advocating for stricter regulations, we can enjoy the glamour of lipstick while minimizing potential health risks and additionally, it provides a comprehensive guide to natural home remedies that can help prevent these side effects. By understanding the potential risks, we can make informed choices about our beauty routines, maintaining healthy, beautiful lips while embracing the love for lipstick.

The relevance of oral exposure in the workplace: a systematic review and meta-analysis.

The inclusion of all relevant exposure routes in the exposure assessment is essential for the protection of workers. However, under European chemical regulations but also for workplace risk assessments according to occupational safety and health (OSH) requirements, the quantitative assessment of oral exposure is usually neglected assuming good occupational hygiene. In contrast, several studies point to the importance of unintentional ingestion in the workplace. To our knowledge, there is no systematic analysis of the extent of this exposure route. Therefore, the aim of this study was to assess systematically the current knowledge on the relevance of occupational oral exposure using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method. Five electronic databases and nine institutional websites were searched for all publications on the relevance. The data were extracted into a concept matrix. In the subsequent meta-analysis, the identified conclusions on the relevance were analyzed. In addition, the measurement methods or modeling approaches that were described for occupational oral exposure were determined as well as the potentially relevant workplaces and substances. In total, 147 studies were included in this analysis that contain a general or several, differentiated assessments of the relevance of occupational oral exposure. Nine of these studies assessed this exposure route as irrelevant. However, 123 studies considered oral exposure as potentially contributing and 80 studies explicitly identified it as relevant. 78 and 94 of the publications described modeling and measurement approaches, respectively. The workplaces frequently identified as potentially or explicitly relevant were other indoor, other industrial or recycling workplaces. Analogously, metals, dust and powders or pesticides were the most frequently investigated substance groups. As several studies assessed occupational oral exposure as relevant in the context of different workplaces and substances, further investigation of this exposure route is needed. This systematic review and meta-analysis serve as a basis for further development of feasible assessment methods for this route of exposure.

Drug-facilitated sexual assault followed by femicidal chloroform poisoning and suffocation: A case-report of criminal responsibility

IntroductionCriminal responsibility evaluation represents one of the most controversial and debated issues in forensic psychiatry. Although clear procedures have been recommended, little research exists on decision-making process by forensic psychiatrists. We present a case assessing the criminal responsibility of a murderer who committed femicide as a result of chloroform poisoning and suffocation after a drug-facilitated sexual assault. Materials and methodsA.S., a 30-year-old female, was found dead in the home of S.P., a 50-year-old male. S.P. recounted killing A.S. by forced inhalation of chloroform, when the woman had experienced sensory clouding following unintentional ingestion of Zolpidem, a hypnotic agent. A multidisciplinary approach was taken to resolve the case. Autopsy, histological, genetic, and toxicological examinations were performed by a forensic pathologist, while a digital forensic examiner analysed electronic devices. A pool of three forensic psychiatrists and two psychologists was asked to assess the mental state of S.P. at the time of the crime. Results and conclusionsThe cause of death of A.S. was identified as a lethal chloroform intoxication in altered consciousness caused by Zolpidem, while homicidal suffocation was also described. Mobile forensics demonstrated that S.P. had videotaped the crime scene, clearly revealing that A.S. had been sexually assaulted by S.P. before dying. Criminal responsibility of S.P. was evaluated through various psychological tests and seven interviews with the accused, each lasting an average of 180 min. Specialists concluded that S.P. could not be exempted from being responsible for the homicide.

Do young children with known cannabis intoxication benefit from further neurological-based testing or imaging?

BackgroundRecent work has demonstrated that children with unintentional cannabis ingestions often undergo extensive ancillary testing such as head imaging or lumbar puncture. To better understand the yield of these tests, our objective was to describe the frequency of additional significant diagnoses in children with cannabis ingestion. MethodsWe performed a retrospective cross-sectional study of the Pediatric Health Information System (PHIS) database, including ED encounters from January 2016 to April 2023 with a diagnosis indicating cannabis exposure in children <6 years of age. We assessed the frequency of co-diagnoses that would be found on head imaging, lumbar puncture, or toxicology testing. ResultsWe included 4132 ED encounters for cannabis ingestion from 47 hospitals. Of these, 1243 (30%) received head imaging and 130 (3.1%) underwent lumbar puncture. There were 23 children (0.6%) with diagnosis of skull fracture or intracranial hemorrhage, 4 (<0.1%) with intracranial neoplasm, and 0 (0%) with a diagnosis for meningitis or intracranial abscess. Presence of discharge diagnosis for other drugs was also uncommon. The most frequent drug ingestion co-diagnoses were cocaine in 43 (1.0%) and opioids in 22 (0.5%) encounters. ConclusionIn children with cannabis intoxication, high rates of head imaging and lumbar puncture are likely driven by the signs of altered mental status at presentation. These data suggest that if cannabis ingestion is considered early and identified quickly with testing, neuroimaging, particularly that with ionizing radiation, may be low yield.

Inadvertent caustic ingestion in children in a tertiary health facility in Enugu: critical review of three cases and current literature

Inadvertent ingestion of corrosive substances occurs frequently in children, especially in the younger age group. This could be attributed to their immaturity and the developmental stage of motor and sensory skills. The most common corrosive agent in our environment is caustic soda, which is used in soap making. This substance is usually stored in unlabelled containers without childproof safety caps. Adequate health education and effective legislation on the production, handling, and storage of corrosive substances will help mitigate the dangers of accidental ingestion in children. We present a report of three cases of unintentional caustic ingestion among children seen in Enugu and discuss the relevant literature.