Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
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Clin Toxicol (Phila) · Jun 2012
The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: guideline methodology.
Extracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from nephrology, clinical toxicology, critical care, or pharmacology and supported by over 30 professional societies. For every poison, the clinical benefit of ECTR is weighed against associated complications, alternative therapies, and costs. ⋯ A modified Delphi method with two voting rounds was used, between which deliberation was required. Each statement was voted on a Likert scale (1-9) to establish the strength of recommendation. This approach will permit the production of the first important practice guidelines on this topic.
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Clin Toxicol (Phila) · Jun 2012
Postpartum maternal codeine therapy and the risk of adverse neonatal outcomes: a retrospective cohort study.
To examine whether postpartum maternal prescription of codeine was associated with an increased risk of harm to newborns. ⋯ In this large population-based study, maternal prescription of codeine following delivery was not associated with death or hospitalization in the early neonatal period.
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Clin Toxicol (Phila) · Jun 2012
Adherence to calcium channel blocker poisoning treatment recommendations in two Canadian cities.
No study has documented whether physicians call poison control centres (PCC) for calcium channel blocker (CCB) poisoning or if interventions suggested by the PCC are being applied. ⋯ In conclusion, the majority of the physicians did not follow PCC recommendations for the treatment of CCB poisoning. Further studies are ongoing as to evaluate the barriers to protocol adherence and to develop evidence based guidelines accompanied by an effective implementation strategy.
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Clin Toxicol (Phila) · Apr 2012
ReviewLevamisole in cocaine: unexpected news from an old acquaintance.
Levamisole is a pharmaceutical with anthelminthic and immunomodulatory properties that was previously used in both animals and humans to treat inflammatory conditions and cancer. Levamisole has been identified as a cocaine adulterant in the United States since 2003. By 2009, the United States Drug Enforcement Administration (DEA) estimated that 69% of the cocaine seized contained levamisole. ⋯ These potential effects make levamisole an interesting choice as a cocaine adulterant. It seems unlikely that levamisole use as a cocaine adulterant will soon reach an end. More information is needed about the diagnosis and treatment of levamisole-induced complications, and the efforts of the medical and public health community is needed to face this challenging problem.
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The hospital mortality from acute poisoning in the western world is approximately 0.6%. However, this figure is based on series of consecutive cases, including mild intoxications. The aim of this paper was to investigate the mortality among poisoned patients with CNS depression on admission. ⋯ Based on the findings in this report, and on a literature search, about 30% of hospitalized poisonings have a significant CNS depression on admission. Based on our experience, cases of poisoning with a GCS score of 7-10 on admission do not seem to have a worse prognosis than poisonings in general. However, cases of poisoning presenting with deeper coma (GCS score 3-6) have a mortality rate approximately seven times higher than the overall hospital mortality from acute poisoning.