Nadużywanie benzydaminy

AbstractWe described the following case of benzydamine hydrochloride oral intoxication used for recreational purpose. The female patient showed extreme excitement with visual hallucinations that persisted for about 10 hours. The benzydamine hydrochloride was used as a drug which is a cheap, easy to acquire and hard to detect. On the basis of the described case and review of the literature, practical psychiatric and toxicological aspects of acute benzydamine misuse and its complications were discussed.StreszczenieW pracy przedstawiono kolejny w Polsce przypadek zatrucia chlorowodorkiem benzydaminy zawartym w preparacie Tantum Rosa. Preparat ten był przyjmowany doustnie w celach rekreacyjnych, a motywem jego używania była chęć znalezienia środka psychoaktywnego, który byłby łatwy do zdobycia, tani i trudny do wykrycia za pomocą powszechnie dostępnych testów narkotykowych. Podobnie jak w opisywanym w 2007 roku przypadku, także i w tym wystąpiło silne pobudzenie psychoruchowe oraz pojawiły się omamy wzrokowe, które utrzymywały się przez ok. 10 godzin. Na podstawie opisanych przypadków, a także przeglądu piśmiennictwa omówiono wybrane praktyczne addyktologiczne i toksykologiczne aspekty używania benzydaminy oraz powikłania z tym związane

Poisoning deaths in Poland : types and frequencies reported in Łódź, Kraków, Sosnowiec, Gdańsk, Wrocław and Poznań during 2009-2013

Objectives: The aim of this study has been to assess the characteristics of acute poisoning deaths in Poland over a period of time 2009–2013. Material and Methods: The analysis was based on the data obtained from the patient records stored in toxicology departments in 6 cities – Łódź, Kraków, Sosnowiec, Gdańsk, Wrocław and Poznań. Toxicological analyses were routinely performed in blood and/or urine. Major toxic substances were classified to one of the following categories: pharmaceuticals, alcohol group poisonings (ethanol and other alcohols), gases, solvents, drugs of abuse, pesticides, metals, mushrooms, others. Cases were analyzed according to the following criteria: year, age and gender of analyzed patients, toxic substance category and type of poisoning. The recorded fatal poisonings were classified according to the International Classification of Diseases. Results: The record of 261 deaths were retrospectively reviewed. There were 187 males (71.64%) and 74 females (28.36%) and the male to female ratio was 2.52. Alcohol group poisonings were more frequently responsible for deaths in men compared to all poisonings, 91.1% vs. 71.6%, respectively (p < 0.05), and pharmaceutical agents were more frequently responsible for deaths in women, 47.4% vs. 28.4%, (p < 0.05). Methanol was the most common agent in the alcohol group poisonings, accounting for 43.75% (N = 49), followed by ethylene glycol, 39.29% (N = 44), and ethanol, 16.96% (N = 19). Conclusions: Epidemiological profile data from investigation of poisoning deaths in Poland may be very useful for the development of preventive programs. Int J Occup Med Environ Health 2017;30(6):897–90

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy. Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388. Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16, p<0·0001). Interpretation: Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice

Cerebral malaria in children: using the retina to study the brain

Cerebral malaria is a dangerous complication of Plasmodium falciparum infection, which takes a devastating toll on children in sub-Saharan Africa. Although autopsy studies have improved understanding of cerebral malaria pathology in fatal cases, information about in vivo neurovascular pathogenesis is scarce because brain tissue is inaccessible in life. Surrogate markers may provide insight into pathogenesis and thereby facilitate clinical studies with the ultimate aim of improving the treatment and prognosis of cerebral malaria. The retina is an attractive source of potential surrogate markers for paediatric cerebral malaria because, in this condition, the retina seems to sustain microvascular damage similar to that of the brain. In paediatric cerebral malaria a combination of retinal signs correlates, in fatal cases, with the severity of brain pathology, and has diagnostic and prognostic significance. Unlike the brain, the retina is accessible to high-resolution, non-invasive imaging. We aimed to determine the extent to which paediatric malarial retinopathy reflects cerebrovascular damage by reviewing the literature to compare retinal and cerebral manifestations of retinopathy-positive paediatric cerebral malaria. We then compared retina and brain in terms of anatomical and physiological features that could help to account for similarities and differences in vascular pathology. These comparisons address the question of whether it is biologically plausible to draw conclusions about unseen cerebral vascular pathogenesis from the visible retinal vasculature in retinopathy-positive paediatric cerebral malaria. Our work addresses an important cause of death and neurodisability in sub-Saharan Africa. We critically appraise evidence for associations between retina and brain neurovasculature in health and disease, and in the process we develop new hypotheses about why these vascular beds are susceptible to sequestration of parasitized erythrocytes

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy.Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388.Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16,

Self-poisonings before and during the initial year of the COVID-19 pandemic in northern Poland

Objectives The objectives of this study included evaluating and reporting on the initial impact of the COVID-19 pandemic and preventive measures in the form of a lockdown on self-poisoning tendencies in northern Poland. Material and Methods The authors retrospectively analyzed medical records of all patients (N = 2990) admitted to the Pomeranian Center of Toxicology in 2018–2020. Of those, further analysis included 2140 patients who had been admitted because of a suicide attempt by self-poisoning. The authors also selected a group of 40 patients on the basis of a self-reported direct relationship of the suicide attempt with the COVID-19 pandemic or the imposed lockdown. Results The rates of suicide attempts in toxicological patients over the years ranged 68.18–75.3%. The patients were predominantly female, with age between M±SD 33.2±16.9 and 36.0±16.4. Each year, over 60% of patients were admitted during their first attempt and were treated psychiatrically prior to their attempt, with differences observed in the COVID-19-related group. The alcohol intoxication during the suicide attempt was confirmed in 37.40–43.53% of the patients, with a higher rate of 52.50% observed in the COVID-19-related group. The main self-reported reason for the suicide was a romantic relationship conflict or breakup, and a conflict and/or violence in the family. The most frequent agents were over-the-counter painkillers, antidepressants, antipsychotics and benzodiazepines or Z-drugs. Conclusions During the initial year of the COVID-19 pandemic, there was a fall of suicide attempts by self-poisonings in northern Poland, significant only in the case of women. The self-reported reasons were similar in all years, with mainly minor changes. There was also an increase in attempts made using benzodiazepines or Z-drugs seen in 2020 and in the COVID-19-related group. The authors believe that there is a need for multi-center, large-scale prospective studies that would provide better insight into the pandemic-related suicidal trends

Cardiogenic shock induced by a high dose of intravenous morphine

Morphine is an opiate alkaloid characterized by various clinical effects, among which the most prominent are its analgesic and psychoactive effects. It also has a prominent depressive effect on the respiratory and cardiovascular system. Because of its psychoactive effect, morphine is very addictive and often used as a recreational narcotic. As a medication, it has found its use as an analgesic agent in chronic pain treatment, in hemorrhagic shock, and in acute heart failure with pulmonary edema. Albeit, morphine use in heart failure is controversial, based on many observational studies showing the negative effect on the outcomes of the patients treated with morphine during acute cardiovascular incidents. In this report, the authors present a case of cardiogenic shock (CS) with transient left ventricular ejection fraction reduction, occurring in a patient attempting suicide using a high dose of intravenous morphine sulphate administration. Other CS causes were ruled out. To the best of the authors’ knowledge, this is the second case of a morphine-related CS reported in literature