Mushroom madness. Psychoactive fungi and the risk of fatal poisoning

Despite its illegality, mushroom use as a hallucinogen is widespread. The reported toxicity of hallucinogenic mushrooms ranges from significant to relatively harmless. The greatest danger lies in the potential for mistaking a highly poisonous variety that contains cyclopeptides for the relatively innocuous hallucinogenic varieties.     

Ackee fruit poisoning: an outbreak investigation in Haiti 2000-2001, and review of the literature

The Centers for Disease Control and Prevention (CDC) provided technical assistance to the Ministry of Health of Haiti during an outbreak of over 100 cases of acute illness and death in the northern region of Haiti during a 4-month period beginning in November 2000. The epidemiologic, clinical, and laboratory findings in this investigation indicated the ingestion of unripe ackee fruit as the most likely cause of this outbreak. This report describes the CDC field investigation in Haiti and gives a brief overview of the current state of knowledge about ackee poisoning.     

Secondary contamination in organophosphate poisoning: analysis of an incident

BACKGROUND: Acute organophosphate poisoning is rare in the UK, and the risks to attending staff are seldom appreciated. STUDY DESIGN: Report of an incident. RESULTS: In May 2001, a 45-year-old man attempted suicide by drinking organophosphate insecticide, and was brought to an urban general hospital in a collapsed state. Twenty-five hospital workers and paramedics sought medical advice after coming into contact with the poisoned patient, of whom ten complained of symptoms related to toxin exposure. Provision of emergency services by the hospital was compromised, and the emergency department was closed until the area was decontaminated and staffing levels could be restored. DISCUSSION: Ingestion of OP compounds can present a significant risk to health professionals as well as patients. Problems with the management of this patient included late recognition of the need for decontamination, large numbers of non-essential staff coming into contact with the patient, and the difficulty of carrying out medical procedures while wearing protective equipment. Decontamination should always be considered early, and the possibility of an ingested poison being vomited and causing a chemical spill should not be overlooked.     

Carbon monoxide poisoning: an A&E perspective.

Carbon monoxide (CO) is a colourless, odourless, tasteless and non-irritating gas and may therefore be inhaled in large quantities by the victim without his realizing it. The toxic effect of CO is not exclusively the result of the binding of haemoglobin; the primary mechanism appears to be inhibition of cellular respiration. Carboxyhaemoglobin (COHb) is excreted fairly rapidly from the body, therefore blood levels do not necessarily reflect the severity of CO poisoning. Airway support and adequate ventilation are the primary objectives of the nursing and medical team. Oxygen is the only antidote to CO. Continuous monitoring of the patient's neurological state is necessary; conscious level is the most important guide to the patient's progress. Nurses must be aware of the clinical indications and contraindications for HBO therapy to ensure that their patients receive optimal treatment.     

Toxicities and outcomes associated with nefazodone poisoning: an analysis of 1,338 exposures

Toxicities and medical outcomes associated with nefazodone poisoning were characterized using national poisoning data from the American Association of Poison Control Centers and through prospective collection of additional data elements. Nefazodone exposures involving concomitant agents were excluded. There were 1,338 human exposures included in the final data analysis. Seventy-five percent of exposures were acute and 20% involved children < 13 years. Twenty-five percent of patients remained asymptomatic. There were no deaths. No dose response relationship was evident in the 45 cases where estimated doses were available. The most common manifestations were drowsiness (17.3% of all patients), nausea (9.7%), and dizziness (9.5%). The most common serious clinical effect was hypotension (1.6%). The median onset time for symptoms was 1.75 hours. Manifestations resolved within 8 to 24 hours. Most patients were treated with only gastrointestinal decontamination. No patients required intubation, mechanical ventilation, or vasopressors. Nefazodone appears to be of low toxicity during poisonings.     

Methanol poisoning: the duality between 'fast and cheap' and 'slow and expensive'.

The management of methanol poisoning includes early antidote therapy to inhibit the metabolism of methanol to formate. Ethanol and fomepizole are both effective, but recently fomepizole has been preferred, although there is no scientific evidence that the use of fomepizole is a superior therapeutic strategy compared with the use of ethanol combined with haemodialysis. The same patient was admitted twice to our emergency department with methanol poisoning. The first time (methanol 3.24 g/l), she was treated with fomepizole without dialysis owing to the absence of acidosis. The second time (methanol 5.5 g/l), she received ethanol as an antidote and dialysis was started. For both therapeutic strategies, hospital length of stay, observation unit length of stay and costs are compared. In the Belgian healthcare system, we found that fomepizole treatment was three times as expensive as ethanol treatment, and the majority of costs are not reimbursed. Fomepizole antidote therapy, compared with ethanol, has fewer reported side effects, but is more expensive. In hospitals where dialysis is easily available, ethanol antidote therapy should still be considered, especially if similar cost differences exist within the healthcare system one is working in.     

Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979- 1996)

OBJECTIVE: Acute respiratory distress syndrome (ARDS) is a devastating clinical disorder that affects critically ill patients with a wide variety of underlying illnesses. Presently, there is limited population-based information concerning both the impact of ARDS on mortality, and the effects of race and gender on national ARDS mortality rates. In this study, we have attempted to evaluate trends over an 18-yr period in deaths associated with ARDS in the United States. DESIGN: Case series. PATIENTS: The Multiple-Cause Mortality Files compiled by the National Center for Health Statistics from 1979-1996 contains information on 38,263,780 decedents. We identified 333,004 decedents who had ARDS. MEASUREMENTS AND MAIN RESULTS: We calculated age-adjusted annual ARDS mortality rates. The annual age-adjusted mortality rate for ARDS initially increased from 1979 (5.0 deaths per 100,000 individuals) to 1993 (8.1 deaths per 100,000 individuals). From 1993 to 1996, the mortality rate for ARDS decreased significantly to 7.4 deaths per 100,000 individuals. Annual ARDS mortality rates have been continuously higher for men when compared with women and for African-Americans when compared with white decedents and decedents of other racial backgrounds. When decedents were stratified by race and gender, African-American men had the highest ARDS mortality rates in comparison to all other subgroups (mean annual mortality rate of 12.8 deaths per 100,000 African-American men). CONCLUSIONS: Although the annual ARDS mortality rate is slowly declining in the United States, significant race and gender differences in ARDS mortality exist.     

Factors associated with hospital retention of RNs in the New York City Metropolitan Area: an analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses

The nursing shortage is well documented, and government estimates indicate that shortfalls will worsen in the future. As the largest employer of registered nurses (RNs), hospitals are the most seriously affected by shortages, as they compete with other employment settings for limited nursing resources. Recruitment remains the primary avenue for ensuring staffing levels, but retention is increasingly important as applicant pools shrink because of demographic and employment trends. Effective retention strategies must address the factors that contribute to exodus of RNs from hospitals, as well as isolating the factors that enable RNs to remain in hospital employment. This secondary analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses examines the demographic, employment, and educational factors associated with working in hospitals, having full-time status, and holding patient care positions. The findings suggest that hospitals must address nonwork issues to retain nursing personnel. Relevant policy issues are examined and strategies for effective retention are offered.     

MYSTIC program: summary of European data from 1997 to 2000.

The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program is a global study providing in-vitro surveillance data on microbial susceptibility in centers that prescribe meropenem. This paper summarizes data on the activity of meropenem and five comparator agents against 13,793 clinical isolates from 31 centers in 10 European countries, 1997-2000. Meropenem and imipenem demonstrated broad-spectrum activity against the tested organisms, including beta-lactamase-producing strains that were co-resistant to quinolones and aminoglycosides. The carbapenems were active against the most frequently isolated pathogens including staphylococci (98-100% susceptible), Pseudomonas aeruginosa (65-82% susceptible) and Klebsiella pneumoniae (98-100% susceptible). Resistance to penicillins and cephalosporins was observed, particularly among Enterobacter species in Southern and Eastern Europe. Eastern Europe showed a high prevalence of AmpC beta-lactamase and extended-spectrum beta-lactamase-producing strains in Russia (2000); 47% and 28% of Enterobacteriaceae isolates were AmpC or ESBL-producers, respectively. There was no significant decrease in susceptibility to the carbapenems throughout the four-year period. Meropenem and imipenem appear to remain reliable options for the treatment of serious nosocomial infections.     

The microcomputer: an alternative for data analysis

Programs for data analysis available on microcomputers now rival those programs available for mainframes in terms of ease of use, accuracy, accessibility, and cost. Researchers should seriously consider the possibilities that exist for data analysis on both the microcomputer and the mainframe. An informed decision will allow best use of available resources.     

一起疑似食物中毒暴发事件的病原学分析

目的 阐明一起疑似由蜡样芽胞杆菌污染奶源引起的食物中毒暴发事件的病原学特征,为查明暴发源头和临床治疗提供依据.方法 对198例患儿进行流行病学调查,采集可疑奶制品和病例标本,进行菌株分离和鉴定.分离到的蜡样芽胞杆菌菌株进行脉冲场凝胶电泳(PFGE)分子分型、全基因组测序以及毒力基因分析.采用微量肉汤稀释法进行药物敏感性...