Accidental pharmacological poisonings in young children: population-based study in three settings

Introduction: Pharmacological poisonings in young children are avoidable. Previous studies report calls to poisons centres, presentations to emergency departments (ED) or hospital admissions. There are limited data assessing concurrent management of poisonings across all three settings. We aimed to describe accidental pharmacological poisonings in young children across our Poisons Information Centre (PIC), EDs and hospitals.

Methods: A population-based study in New South Wales, Australia, of PIC calls, ED presentations and hospital admissions for accidental pharmacological poisoning in children aged <5 years, 2007–2013. We examined trends, medicines responsible and subsequent management. Medicines were coded using ICD10-AM diagnosis codes (T36-50).

Results: Over 2007–2013, pharmacological poisonings accounted for 67,816 PIC calls, 7739 ED presentations and 2082 admissions. Rates (per 10,000 children) of PIC calls declined from 220 to 178; ED presentations were stable (～22–24), with a decrease in emergency cases offset by an increase in semi- or non-urgent presentations; hospital admissions declined (8–5). Most PIC calls related to “non-opioid analgesics” (25%), and “topical agents” (18%). Nearly every day, one child aged <5 years was admitted to hospital for poisoning. “Benzodiazepines”, “other and unspecified antidepressants”, “uncategorised antihypertensives”, and “4-aminophenol derivatives” accounted for over one-third of all admissions. Most PIC calls (90%) were advised to stay home, 6% referred to hospital. One-quarter of ED presentations resulted in admission.

Conclusions: Poisonings reported to PIC and hospitals declined, however, non-urgent ED presentations increased. Strategies to reduce therapeutic errors and access to medicines, and education campaigns to improve Poisons Centre call rates to prevent unnecessary ED presentations are needed.     

New legal requirements for submission of product information to poisons centres in EU member states

Introduction: In the past eight years, the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) has been intensively involved in a European Commission led process to develop EU legislation on the information of hazardous products that companies have to notify to EU Poisons Centres (or equivalent “appointed bodies”). As a result of this process, the Commission adopted Regulation (EU) No 2017/542, amending the CLP Regulation by adding an Annex on harmonised product submission requirements.

Harmonised mixture information requirements: Detailed and consistent information on the composition of the hazardous product will become available to EU Poisons Centres (PC). The information will be submitted by companies to PCs (or equivalent “appointed bodies”) using a web-based software application or in-house software. Two new important features are introduced. Firstly, to be able to rapidly identify the product formula, a Unique Formula Identifier (UFI) on the product label links to the submitted information. Secondly, for better comparability of reports on poisonings between EU member states, a harmonised Product Categorisation System will specify the intended use of a product. Rapid product identification and availability of detailed composition information will lead to timely and adequate medical intervention. This may lead to considerable reduction in healthcare costs.

Additionally, for companies trading across the EU, costs of submission of this information will be reduced significantly.

Next steps: From 2017, an implementation period has started, consisting of a three-year period for stakeholders to implement the new requirements, followed by a gradual applicability for consumer products (2020), professional products (2021) and industrial use-only products (2024). Technical tools to generate the electronic format and the UFI together with guidance documents are expected to be made available by the end of 2017 by the European Chemicals Agency (ECHA). Guidance on interpretation of legal text and ECHA helpdesk support are planned to be ready at the end of 2018.     

2009-2011年宁夏部分企业有毒有害作业工人职业健康监护分析

目的分析宁夏部分有毒有害作业工人职业健康监护现状,为宁夏回族自治区职业病防治决策提供依据。方法对宁夏部分企业有毒有害作业工人职业健康监护情况进行描述性研究,分析不同企业规模、经济类型、行业性质及接触不同有害因素作业工人的健康监护情况,并分析2009～2011年职业健康监护变化趋势。结果2009～2011年宁夏各种有毒有害作业工人职业健康体检受检率呈总体上升趋势。疑似职业病栓出率大型企业最高,小型企业最低;国有企业最高,集体和外资企业最低。煤炭行业、粉尘作业工人疑似职业病检出率最高,粉尘是主要危害因素。结论应进一步加强职业病宣传、监督及人才队伍建设,提高健康监护工作水平。     

中毒事件中四种鼠药的快速检测

目的建立对四种鼠药的实验室应急检测方法,以应对突发公共卫生毒物中毒事件。方法采用气质联用法(GC/MS)测定毒鼠强、氟乙酰氨和高效液相色谱法(HPLC)测定敌鼠钠、溴敌隆,以鼠药标准和鼠药样品为对象,优化GC/MS和HPLC色谱、质谱条件,从而建立各鼠药的色谱图库和质谱图库。结果 GC/MS定性检测毒鼠强的特征离子和丰度比分别为212/240和2:1,氟乙酰胺的分别为44/77和1.5:1;敌鼠钠、溴敌隆以高效液相色谱双波长(285nm和260nm)检测,固体样品最低检测浓度为0.80 mg/kg,液体样品最低检测浓度为0.16 mg/L。结论研究方法对中毒事件中四种鼠药检测快速、结果可靠,适用于鼠药中毒实验室应急检测。     

1334例免费肺结核病人毒副反应的发生情况及处理分析

目的：分析在我地使用板式组合抗结核药治疗病人的毒副反应发生几率与严重程度，探索相应对策，降低毒副反应的发生。方法：采用不住院短程间歇化疗方法，全程监督管理，对有毒副反应者进行个案调查，妥善处理详细记录，填好个案调查表，然后进行数理统计分析。结果：零陵区从1999年1月-2005年12月7年间采用板式组合抗结核药治疗1334例涂阳肺结核病人，其中有257例出现了不同程度的毒副反应，发生率为19．27％，最严重者表现为肝肾损害，经妥善处理无病例死亡，并全部按原方案完成疗程。结论：板式组合药对约20％的患者存在一定的毒副作用，但经过临床医生的妥善处理，患者完全可以最大限度的避免因药物毒副作用而中断治疗。     

Prospective study of definite caterpillar exposures.

Exposure to caterpillars results in a variety of clinical effects depending on the species involved. The aim of this study was to describe the clinical effects from caterpillar exposures within Australia. Cases were recruited prospectively from calls to a poison information centre. Subjects were included if they had a definite exposure and they had collected the caterpillar or cocoon. The caterpillars were identified to genus and species level where possible. There were 36 included cases: two were contact exposures to caterpillar contents, one was an ingestion of a caterpillar and the remaining 33 patients had definite reactions from caterpillar or cocoon exposure. There were five families of caterpillars identified in the study: Arctiidae, Limacodidae, Anthelidae, Lymantriidae and Sphingidae, many of which occur worldwide. Clinical effects ranged from severe pain to an urticarial response depending on the species involved. There were no adverse effects following ingestion in this study. Treatment consisted primarily of removal of the caterpillar or cocoon. Other treatment measures consisted of symptomatic treatment such as ice packs and antihistamines. This is the first prospective study of caterpillar exposures within Australia and demonstrates that exposures can result in a variety of reactions depending on the family and species involved.     

Drug information in Zimbabwe: 1990–1999

Objective To assess the utilisation and development of the Zimbabwe Drug And Toxicology Information Service (DATIS) Setting The national drug and poisons information centre in Harare, Zimbabwe. Method A survey of records at the Zimbabwe national Drug and Toxicology Information Service (DaTIS) for the period January 1990 to December 1999 was conducted and compared to a previous review. Main outcome measures Average annual reporting rate, distribution of service users and report categories Results The mean (SD) reporting rate was 142.9 (81.6) p.a. with an increasing trend. Most contacts came from the capital city (67%). Pharmacists (40%) predominated in requests for drug information (DI), which comprised about three-quarters of reports, whereas toxicological enquiries mostly came from physicians (49%). Therapeutic categories mentioned most in DI reports were systemic anti-infective (24%) and nervous system agents (20.4%). Pesticides (28%) predominated in toxicology requests followed by pharmaceuticals (21%), largely nervous system (36%) and antiparasitic agents (23%). Conclusion Compared to the previous decade, use of DaTIS had not grown significantly due to perceived resource constraints, lack of local political and institutional support and divided loyalty of staff. The drug and poison information components serves two distinct user populations with separate needs. Development plans for both DaTIS and other drug information services in Africa need to be realistic taking into account the resource constraints and local political and institutional support.     

The Sentinel Role of Poisons Centers in the Protection of Children's Environmental Health

Growing concern exists about the threats posed by environmental pollutants and physical agents on children's health. A number of factors, including globalization, increased industrialization, and trade of chemicals and poverty have an impact on the quality of the environment and on children's health. Acute toxic exposures lead to poisoning, and chronic low-level exposures may cause functional and organ damage during periods of special vulnerability. The need to protect children's environmental health is urgent, in view of the magnitude of the problem and the fact that “children are not little adults.” The effects suffered during special developmental periods—“windows of vulnerability”—can be permanent and irreversible. The main global environmental problems affecting children's health are lack of access to safe drinking water and sanitation and exposure to indoor air pollution. Furthermore, environmentally related accidents, injuries, and poisonings have a major impact on children and adolescent's morbidity and mortality. A number of examples that illustrate the complexity of assessing and dealing with children's environmental health issues are presented. A Task Force on the Protection of Children's Environmental Health that aims to prevent disease and disability in children associated with chemical and physical threats was set up in 1999 by the World Health Organization. The priorities for action include the consideration of accidents, injuries, and poisonings (accidental, intentional, and occupational), and children in the workplace (e.g., scavenging children, children in cottage industries). Poisons Centers and related toxicology centers are in a strategic position to play a “sentinel” role in the protection of children's environmental health. They record acute and chronic toxic exposures in children in a harmonized manner, using controlled vocabularies and definitions. This will allow collecting a large, highly valuable database on the main toxicological problems affecting children, including those of environmental origin. The analysis of observations entered in such a database will help assess the burden of disease and collect the evidence for planning prevention and promoting regulatory measures. Centers are called to play a proactive role in raising awareness about children's environmental health and contribute to research, information dissemination, training, and other activities required for the protection of children's health and development.     

"Sign of the kiss" in dermatitis caused by vesicant beetles ("potós" or Paederus sp.)

The cosmopolitan beetles of the Paederus genus (potós) cause a severe dermatitis when the insect is crushed against the skin of exposed areas (the cervical region is the most affected). Toxins (pederin and others) from the hemolymph of the insect cause plaques and/or bizarre, linear lesions with erythema, edema, blisters, pustules, crusts and exulcerations. There may be a burning sensation and severe conjunctivitis. Lesions disappear after 10 days and may leave hyperchromic macules. Treatment is made with topical corticosteroids and intensive washing.