2016 Annual Report of the University of Kansas Health System Poison Control Center

Introduction. This is the 2016 Annual Report of the University ofKansas Health System Poison Control Center (PCC). The PCC is oneof 55 certified poison control centers in the United States and servesthe state of Kansas 24 hours a day, 365 days a year, with certified specialistsin poison information and medical toxicologists. The PCCreceives calls from the public, law enforcement, health care professionals,and public health agencies. All calls to the PCC are recordedelectronically in the Toxicall® data management system and uploadedin near real-time to the National Poison Data System (NPDS), whichis the data repository for all poison control centers in the U.S. Methods. All encounters reported to the PCC from January 1, 2016to December 31, 2016 were analyzed. Data recorded for each exposureincludes caller location, age, weight, gender, substance exposedto, nature of exposure, route of exposure, interventions, medicaloutcome, disposition and location of care. Encounters were classifiedfurther as human exposure, animal exposure, confirmed non-exposure,or information call (no exposure reported). Results. The PCC logged 21,965 total encounters in 2016, including20,713 human exposure cases. The PCC received calls from everycounty in Kansas. The majority of human exposure cases (50.4%, n =10,174) were female. Approximately 67% (n = 13,903) of human exposuresinvolved a child (defined as 19 years or less). Most encountersoccurred at a residence (94.0%, n = 19,476) and most calls (72.3%, n= 14,964) originated from a residence. The majority of human exposures(n = 18,233) were acute cases (exposures occurring over eighthours or less). Ingestion was the most common route of exposuredocumented (86.3%, n = 17,882). The most common reported substancein pediatric encounters was cosmetics/personal care products(n = 1,362), followed by household cleaning products (n = 1,301). Foradult encounters, sedatives/hypnotics/antipsychotics (n = 1,130) andanalgesics (n = 1,103) were the most frequently involved substances.Unintentional exposures were the most common reason for exposures(81.3%, n = 16,836). Most encounters (71.1%, n = 14,732) weremanaged in a non-healthcare facility (i.e., a residence). Among humanexposures, 14,679 involved exposures to pharmaceutical agents while10,176 involved exposure to non-pharmaceuticals. Medical outcomeswere 32% (n = 6,582) no effect, 19% (n = 3,911) minor effect, 8% (n =1,623) moderate effect, and 2% (n = 348) major effects. There were 15deaths in 2016 reported to the PCC. Number of exposures, calls fromhealthcare facilities, cases with moderate or major medical outcomes,and deaths all increased in 2016 compared to 2015. Conclusions. The results of the 2016 University of Kansas HealthSystem Poison Control annual report demonstrates that the centerreceives calls from the entire state of Kansas totaling over 20,000human exposures per year. While pediatric exposures remain themost common, there is an increasing number of calls from healthcarefacilities and for cases with serious outcomes. The experience of thePCC is similar to national data. This report supports the continuedvalue of the PCC to both public and acute health care in the state ofKansas. Kans J Med 2018;11(2):24-33

2018 Annual Report of the University of Kansas Health System Poison Control Center

Background. This is the 2018 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System (KSPCC). The KSPCC serves the state of Kansas 24-hours per day, 365 days a year with certified specialists in poison information and clinical and medical toxicologists.  Methods. All encounters reported to the KSPCC from 01/01/2018 through 12/31/2018 were analyzed. Data recorded for each exposure included caller location, age, weight, gender, exposure substance, nature of exposure, route of exposure, interventions, medical outcome, disposition, and location of care.  Results. There were 21,072 total encounters, including 20,031 human exposure cases. Calls were received from every county and hospital in Kansas. Most of the exposures involved females (51.5%, n = 10,320) and a child less than 19 year of age (64%, n = 12,865). Medical outcomes were 24.5% (n = 4,912) no effect, 17.7% (n = 3,542) minor effect, 9.1% (n = 1,830) moderate effect, and 2.4% (n = 476) major effect. Seven deaths were reported in 2018. The number of exposure calls from healthcare facilities and severity of medical outcomes increased in 2018 compared to 2017.  Conclusions. The 2018 KSPCC annual report demonstrated that the center receives calls from the entire state of Kansas totaling over 20,000 human exposures. While pediatric exposures remain the most common encounter, a trend continued of an increasing number of calls from healthcare facilities and for cases with serious outcomes. This report supported the continued value of the KSPCC to both public and acute health care in the state of Kansas

Commentary on using the SF-36 or MOS-HIV in studies of persons with HIV disease

The purpose was to compare and comment on use of the SF-36 and MOS-HIV instruments in studies of persons with HIV disease. Three medical information databases were searched to identify examples of HIV studies that included the MOS-HIV or SF-36. Thirty-nine and 14 published articles were identified for illustration in comparing the use of the MOS-HIV and SF-36 in HIV disease, respectively. Support for the reliability and construct validity of the MOS-HIV and SF-36 was found. Ceiling and floor effects were reported for both the MOS-HIV and SF-36; however, ceiling effects were more common for the MOS-HIV, in part due to fewer items in the physical, social, and role functioning domains. The MOS-HIV measures three domains hypothesized to be associated with the health deterioration of HIV disease not measured by the SF-36; however, these domains may not assess aspects of HIV disease that typify the majority of the persons with HIV disease today. National norms for the U.S. adult population (and other nations) are available for the SF-36. In addition, the SF-36 has been used in a wide variety of patient populations, enabling comparisons of HIV-infected persons with persons with other health conditions. No national norms for the MOS-HIV are available. We conclude that there is currently insufficient evidence in the literature to recommend the use of the MOS-HIV over the SF-36 in HIV-infected persons. Although the SF-36 is not targeted at HIV, it may be preferable to use the SF-36 over the MOS-HIV due to fewer ceiling effects, availability of national norms, and the vast amount of data for other populations in the U.S. and around the world. Head-to-head comparisons demonstrating the unique value of the MOS-HIV over the SF-36 are clearly needed. More importantly, additional work needs to be directed at comparing the MOS-HIV and other putatively HIV-targeted instruments to one another to help demarcate aspects of HRQOL that are truly generic versus specific to HIV disease. Using both a generic and targeted HRQOL measure is a good general strategy, but this has not been a typical practice in studies of HIV because the MOS-HIV is so similar in content to the SF-36

Langerhans Cell Histiocytosis in an Adult With Involvement of the Calvarium Cerebral Cortex and Brainstem: Discussion of Pathophysiology and Rationale for the use of Intravenous Immune Globulin

We report a case of Langerhans cell histiocytosis in a 64-year-old male who presented with symptoms and signs of brain involvement, including seizures and hypopituitarism. The diagnosis was confirmed with a biopsy of a lytic skull lesion. The disease affecting the bone showed no sign of progression following a short course of cladribine. Signs of temporal lobe involvement led to an additional biopsy, which showed signs of nonspecific neurodegeneration and which triggered status epilepticus. Lesions noted in the brainstem were typical for the paraneoplastic inflammation reported in this condition. These lesions improved after treatment with cladribine. They remained stable while on treatment with intravenous immune globulin

Allogeneic Astrocytoma In Immune Competent Dogs

AbstractWe have induced in canines long-term immune tolerance to an allogeneic cell line derived from a spontaneous canine astrocytoma. Allogeneic astrocytoma cells were implanted endoscopically into the subcutaneous space of fetal dogs before the onset of immune competency (<40th gestational day). At adulthood, dogs rendered tolerant successfully serve as recipients of intracranial transplants of their growing allogeneic, subcutaneous tumor. Transplanted dogs subsequently develop a solid brain tumor with histological features similar to the original astrocytoma. This model may allow rapid development and evaluation of new therapies for brain tumors, as well as afford tumor biology studies that are untenable in smaller, immune incompetent, or inbred animals harboring less representative tumors