应用HACCP原则在餐饮业中的作用

目的：在餐饮业中应用HACCP管理系统，保证食品质量安全，预防食物中毒发生。方法：分析1995∽1999年日照市5年内12家单位食物中毒发生的特点，找出存在的危害环节，制订控制措施，成立以经理、厨师、采购员、服务员领班为成员的领导小组，通过监督部门培训指导，负责实施HACCP计划。结果：自2000年，在实施HACCP管理单位中，未再发生食物中毒。结论：在餐饮业应用HACCP管理是有效的。将HACCP原则作为执行标准是必要的。     

1989至2003年全国金属及类金属化合物重大急性职业中毒的特征

目的通过分析我国报告发生的金属及类金属化合物重大急性职业中毒事故的发生特点,提出优先、重点的防制建议。方法对1989至2003年全国报告发生的金属及类金属化合物重大急性职业中毒资料进行整理和分析。结果15年间共报告金属及类金属化合物重大急性职业中毒39起,年均2．6起,直接导致中毒的金属及类金属化合物约13种。确诊中毒609例,死亡32例,平均每起事故中毒15．6例,中毒死亡0．8例,总中毒率为52．9%,总中毒死亡率为5．3%；平均中毒年龄(29．2±9．0)岁,平均中毒死亡年龄(32．3±9．9)岁。自1997年起报告的中毒事故增多,43．6%的中毒由砷化氢导致；发生在制造业和化学工业的中毒较多,清洗和搬运作业易发生中毒。导致中毒事故发生的主要原因是没有密闭通风排毒设备或效果不好(22．5%)、没有个人防护设备(19．8%)、缺乏安全教育(19．8%)和没有安全操作规程(15．3%)等。结论加强砷化氢、砷及其化合物的急性中毒防治,注意在冬夏两季有针对性地加强安全教育和个人防护。     

广州地区重大化学危害源识别和中毒控制与应急医疗技术预案库制备的研究

目的识别、确定广州地区存在的可能引起重大化学危害(含职业危害)事故的毒物谱库,为化学事故应急救援行动提供技术依据。方法⒈应用循证医学的方法,研究分析包括从安监部门登记的化学品资料中识别出广州地区存在的重大化学(含职业危害)危害源,筛选与其相关的中毒控制与应急医疗技术资料数据;⒉应用计算机技术编制成数据库文本和应用软件。结果⒈制成广州地区重大化学(含职业危害)危害源的中毒控制与应急医疗技术预案库文件文本与应用软件;⒉建立广州地区化救技术网络信息服务平台,向社会提供有关化学品的毒性、化学事故预防控制及应急处置、应急医疗技术预案信息。结论该中毒控制与应急医疗技术预案库,可作为化学事故应急救援行动的技术依托,使政府部门启动化学事故应急救援预案时,从技术预案库快速查询到化学事故应急救援行动所需的决策依据。     

学龄儿童家长铅中毒知识-态度-行为的调查分析

目的:了解和掌握学龄儿童家长儿童铅中毒知识、态度、行为现状,为制定合理的健康教育规划提供基础材料。方法:采用随机整群抽样方法,在大理市城区16所小学随机抽取350名家长进行问卷调查,测评其对儿童铅中毒的认识、态度、行为知晓率。结果:学龄儿童家长对工业性铅污染源的认识较清楚(66.1%～83.0%),但对生活中一些不易察觉铅污染源认识存在不足(56.9%～83.9%)。掌握铅污染源、铅在体内转运转化知识较多者主要是父母的文化层次和家庭经济收入较高者,多数家长对儿童铅中毒健康教育持赞成态度。结论:学龄儿童家长对铅中毒知识了解不够,亟待加强教育。     

无锡市锡山区餐饮业操作环境卫生学调查

目的:了解无锡市锡山区餐饮业的卫生状况,探索细菌性食物中毒的预防和预警机制。方法:对辖区内98家餐饮单位进行调查及抽样检测。结果:大型餐饮单位和集体食堂的卫生设施的齐全、合格率达95%以上,中、小型餐饮单位的齐全合格率仅为59.35%,93.9%的餐饮单位均对餐具实施消毒,但消毒措施的规范合格率仅占34.7%;从业人员的卫生知识知晓率仅为40.0%;所采集的112件餐饮业熟食间工具、用具样品的菌落总数及大肠菌群的合格率分别为30.35%和47.3%,在98名从业人员的手指涂抹标本中,有4人检出致病菌,致病菌带菌率为4.1%。区疾病预防控制中心对在调查中检出致病菌的单位发出了食物中毒预警函,并由乡镇医院防保科负责指导消毒工作。结论:该市应加强食物中毒的预防和建立预警机制,制作了分析探讨。     

急性中毒患者血液毒鼠强的GC/MS检测及临床应用

目的利用气相色谱-质谱（GC/MS）建立一种快速检测中毒患者血液毒鼠强的方法.方法考察5种有机溶剂液-液法提取血液毒鼠强的回收率,研究毒鼠强的线性方程、最低检测限及精密度.结果乙酸乙酯提取毒鼠强的回收率为90.40%,RSD=2.8%,n=5;毒鼠强线性方程为y=156.5x＋236.1,R=0.9988;最低检测限为4ng/ml;日内精密度为RSD为4.3%,日间精密度为RSD为6.7%.解析了毒鼠强质谱图的主要碎片归属.结论所建方法简单快速,灵敏度高,选择性好,可用于临床中毒患者血液毒鼠强的检测.     

解磷注射液氯磷定治疗急性有机磷农药中毒

目的观察解磷注射液合用氯磷定治疗急性有机磷农药中毒的疗效。方法对74例急性有机磷农药中毒患者用解磷注射液及氯磷定治疗(治疗组),对68例急性有机磷农药中毒患者按传统治疗方法治疗(对照组),观察两组疗效。结果治疗组平均用药(5.1±2.5)次,胆碱酯酶(ChE)恢复时间平均为(18±1.4)h,平均住院时间为(4.4±2.5)天,阿托品中毒2例,死亡3例。对照组平均用药(13.7±5.4)次,ChE恢复时间平均为(27±1.2)h,平均住院(7.5±2.6)天,阿托品中毒6例,死亡2例。结论解磷注射液合用氯磷定治疗急性有机磷农药中毒疗效高,阿托品中毒机会少,用药方便。     

The Toxicology Investigators Consortium Case Registry—the 2013 Experience

The Toxicology Investigators Consortium (ToxIC) Case Registry was established in 2010 by the American College of Medical Toxicology. The Registry includes all medical toxicology consultations performed at participating sites. This report summarizes the Registry data for 2013. A query of the ToxIC Registry was carried out for the dates of January 1 through December 31, 2013. Specific data reviewed for analysis included demographics (age, gender), source of consultation, reasons for consultation, agents involved in toxicological exposures, signs, symptoms and clinical findings, and treatment. A total of 8,598 cases were entered into the Registry in 2013. Females accounted for 49.2 % of cases, males for 47.7 %, and gender was not reported in 3.1 %. The majority of patients (63.4 %) were adults between the ages of 19 and 65 years. There were 93 fatalities (1.1 %). Most referrals for medical toxicology consultation originated from the emergency department (59.7 %) or inpatient services (16.7 %). Exposures to pharmaceutical products (intentional and unintentional) made up 50.0 % of cases. Illicit drug abuse (8.0 %) and adverse drug reactions (ADRs) (4.8 %) were the next most frequent reasons for consultation. Similar to past years, nonopioid analgesics, sedative-hypnotics, and opioids were the most commonly encountered agents. Symptoms or clinical findings were documented in 71.1 % of patients. Of all cases, 54.6 % required some form of medical treatment (antidotes, antivenom, chelation, specific types of supportive care). This report serves as a comprehensive survey of medical toxicology practice within participating institutions. Prior trends continued to apply this year and indicate analgesic (opioid and nonopioid), sedative-hypnotic/muscle relaxant agents, illicit drug use, and ADRs continue to be major toxicological problems. Cases requiring medical toxicology consultation in 2013 predominantly involved pharmaceuticals and illicit drugs. Reasons for these drug exposures were diverse and included intentional overdose, unintentional exposure, withdrawal syndromes, and ADRs. Nonopioid analgesics, sedative-hypnotic agents, and opioids remained the most frequently encountered agent classes. While over half of cases required some form of medical treatment, fatalities were uncommon.     

Outcomes with bilateral cochlear implantation following sudden dual sensory loss after ethylene glycol poisoning

Abstract

Acute loss of vision accompanied by profound loss of hearing is fortunately rare, but has a catastrophic effect on both the patient and their family. Re-establishing communication and spatial awareness are high priorities. We describe the case of a 45 year-old man who presented as a result of poisoning by ethylene glycol. Following assessment by clinicians who learned the deaf-blind alphabet in order to communicate, he had his hearing successfully rehabilitated with simultaneous bilateral cochlear implants. The patient recovered the ability to understand speech near perfectly in quiet, to attend to the ear giving the clearer signal in noise, and to localise sources of sound. The patient reported that the latter skill facilitated mobility. This is the first reported case of a patient with acute dual sensory loss due to ethylene glycol poisoning benefiting from bilateral cochlear implants.     

Usefulness of the serum lactate concentration for predicting mortality in acute beta-blocker poisoning

Context.?Serum lactate measured in the emergency department was recently assessed as an excellent prognosticator of drug-overdose fatality, with the optimal lactate cutoff point being 3.0 mmol/L. However, lactate's role has never been specifically studied in beta-blocker poisonings. Objective.?We aimed to evaluate the ability of lactate concentrations to predict outcome (survival versus death) in beta-blocker poisoning. Methods.?We conducted an 8-year retrospective study for all symptomatic beta-blocker poisonings admitted to our toxicological intensive care unit (ICU). Serum lactate concentrations were measured in 110 patients and final outcomes of survival or death recorded. Results.?Lactate concentrations were 1.79 mmol/L [0.8–5.6] (median, 10–90% percentiles) and peak values of 1.9?mmol/L [0.9–9.5] (p?<?0.0001). Nine patients (8%) died in the ICU. Admission serum lactate concentrations differed significantly between survivors and fatalities (p?=?0.0008). Four patients (44% of the non-survivors) died in the ICU despite lactate concentrations lower than 3.0?mmol/L. The diagnostic characteristics of the 3.0?mmol/L selected lactate cutoff point were 55% sensitivity and 80% specificity. Conclusion.?Serum lactate elevation in beta-blocker poisoning is relatively mild on admission despite the presence of significant cardiovascular symptoms. Even if raised in severe poisonings and alone correlate well with prognosis, lactate concentration is not an absolute predictor of beta-blocker-overdose fatality.