Uus ravijuhendite veeb on avatud

Eesti Arst 2017; 96(9):511–51

Mürgistustega seotud ravijuhendid ja antidootide info uuel veebilehel

Eesti Arst 2020; 99(2):72–7

Mürgistustega seotud ravijuhendid ja antidootide info uuel veebilehel

Eesti Arst 2020; 99(2):72–7

Estonian Experience on Establishment of a Modern National Poison Information Centre: One-year Profile of Phone Calls in 2012

Background: Initiating a National Poisoning Information Centre (PIC) in Estonia took about 12 years of challenging work on research, training and attracting governmental support and funding. In this study we described the establishment process and the profile of phone calls in the first year which the PIC started to be available full time (24h/day 7days/week).  Methods: This was a descriptive retrospective study. Relevant documents from 2000-2012 were reviewed. The documents were categorized into 5 main issues against establishment of PIC. Data of all inquiries related to toxic agent exposures regarding patient’s demographic, intention of poisoning and type of toxic substances in 2012 were collected. The data were reported with frequency and percentage. Results: During establishment process, 386 documents including governmental regulations and contracts, memorandums from meetings, professional e-mails, newspaper articles, interviews, annual reports and program sheets of other poison centres and conference presentations were collected. Funding was provided form PHARE and BTox projects (2000-2003), and government of Estonia (2004-2012). Educational programs were held to train specialists in clinical toxicology and poisoning information to direct the PIC. The active phase of establishment started in 2004; however, the services of PIC became available at the beginning of 2008. In 2012, total number of calls was 1118. 20% of calls were related to general questions about pharmaceuticals and non-toxic agents. 894 calls were related to acute poisoning cases. Most of them (87.9%) were due to accidental poisoning. The most common types of substances responsible for poisoning were pharmaceutical products (30.2%), household products (29.5%) and plant toxins (11.1%). Conclusion: To establish a stable PIC, it is crucial to have a wide range data backbone, clear support and direct funding from the government, assistance from collaborative PICs, active international/domestic collaboration and experienced committed specialists in clinical toxicology. A well-established PIC improves public health surveillance and reduces health-care costs. These effects should be investigated in future studies about the National PIC of Estonia

Nööppatarei neelamine lapseeas – haigusjuhud ja kirjanduse ülevaade

Nööppatarei neelamisega võivad lastel kaasneda rasked tüsistused ja isegi surm. Kõige suuremat ohtu kujutab söögitorru peetunud patarei, söögitoru raske kahjustus võib tekkida kahe tunni jooksul. Esmases diagnostikas on oluline koht kahes vaates tehtud röntgenipiltidel. Hilisemate tüsistuste ennetamiseks on kõige olulisem patarei kiire endoskoopiline eemaldamine. Eemaldamise järel tuleb jälgida patsienti võimalike tüsistuste suhtes, millest ohtlikem, fistul suurte veresoontega, võib lõppeda surmaga. Ülevaate eesmärk on iseloomustada kolme näite põhjal nööppatareide neelamise raskema kuluga juhtumeid, analüüsida ajakohast praktikat ja pakkuda tegevuse algoritmi selliste juhtumite käsitluseks

66. Poison centre data on botulism: results from an EAPCCT survey 39th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 21-24 May 2019, Naples, Italy

Objective: To collect epidemiological data and information on the clinical management, diagnostic capability and antidote availability in cases of botulism in poison control centers/poisoning treating facilities (PCCs) located in different countries. Methods: An electronic survey was sent to EAPCCT members in March 2018. The survey included 19 questions on (i) epidemiological data (registered by PCCs during 2015-2017) as well as questions on (ii) availability/location of specific laboratory, (iii) clinical management, (iv) type of antitoxin availability (including dosage/adverse drug reaction) and (v) its location. A reminder email was sent after 3 weeks. Results: Fourteen PCCs completed the survey (Austria, Belgium, Czech Republic, Estonia, France, Germany, Greece, Iceland, Ireland, Italy, Poland, Slovenia, South Africa and Switzerland). Ireland, Estonia, Slovenia and Poland PCCs declared no experience with botulism because cases were managed by Infectious Diseases Services. Therefore 10 questionnaires were analyzed. Cases of foodborne botulism, infant and adult intestinal botulism, and wound botulism were registered by PCCs. Specific laboratories for diagnosis are available in 7 countries (70%), all located in government services (in 2 countries operative 24 hours). The detection of botulinum/ botulinum producing clostridia is carried out by polymerase chain reaction (PCR) and in vivo tests. Turnaround time (TAT) varies from 2 to 72 hours for PCR and from 12 hours to 7 days for in vivo testing. All PCCs, except two, prescribe antidote before laboratory confirmation. Trivalent Equine Antitoxin is the unique formulation available, and the dosage varies from 1 to 4 bottles. No severe acute adverse reactions have been reported. Antitoxin is stocked in PCCs/hospitals/pharmacies and in 6 countries in strategic stockpiles. Conclusion: PCC experience on botulism varied greatly: some services manage all cases occurring in the country as reference centers, while others refer to Infectious Diseases Services. During the study period (3 years), all forms of botulism have been observed by PCCs (including rare forms such as wound and intestinal botulism). PCR diagnosing testing is not routinely available, and in vivo tests remain the gold standard, even if, accordingly, TAT is too long to be useful in the first phase of clinical management. Trivalent Equine Antitoxin is available, and administration is safe. On the contrary, the recommended dose varies significantly among countries. Antidote storage in strategic stockpiles may be useful to manage public health emergencies or unconventional events. A harmonization of management of botulism between PCCs would seem appropriate for the future

Characteristics and outcomes of e-cigarette exposure incidents reported to 10 European Poison Centers : a retrospective data analysis

BACKGROUND: The use of e-cigarettes has increased during the past few years. Exposure to e-cigarette liquids, whether intentional or accidental, may lead to adverse events our aim was to assess factors associated with e-cigarette exposures across European Union Member States (EU MS). METHODS: A retrospective analysis of exposures associated with e-cigarettes reported to national poison centers was performed covering incidents from 2012 to March 2015 from 10 EU MS. De-identified and anonymous raw data was acquired. RESULTS: In total, 277 incidents were reported. Unintentional exposure was the most frequently cited type of exposure (71.3%), while e-cigarette refill vials were responsible for the majority of the reported incidents (87.3%). Two-thirds of all exposures (67.5%) occurred as ingestion of e-liquids, which was more frequent among children (≤ 5 years, 6-18 years) compared to adults (87.0% vs. 59.3% vs. 57.6%, p < 0.001 respectively), exposure via the respiratory (5.4% vs. 22.2% vs. 22.2%, p < 0.001) were more frequent among paediatric patients while ocular routes (2.2% vs. 3.7% vs. 11.4%, p = 0.021) were more frequent among adults. Logistic regression analyses indicated that paediatric incidents (≤ 5 years) were more likely to be through ingestion (adjusted Odds Ratio [aOR] = 4.36, 95% Confidence Interval [C.I.]: 1.87-10.18), but less likely to have a reported clinical effect (aOR = 0.41, 95% C.I.: 0.21-0.82). CONCLUSIONS: Our study highlighted parameters related to e-cigarette exposure incidents in 10 EU MS, the results of which indicate that consideration should be given to the design features which may mitigate risks, thereby protecting users, non-users and especially children