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JMT Musings: From the Impostor Syndrome to Humility. JMT Musings:从 "冒名顶替综合症 "到 "谦逊"。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-28 DOI: 10.1007/s13181-024-01012-1
Leslie R Dye
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引用次数: 0
Safety of Physostigmine for Pediatric Antimuscarinic Poisoning. Physostigmine 用于治疗小儿抗心绞痛药中毒的安全性。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-01-24 DOI: 10.1007/s13181-024-00988-0
Sarah Huber, Robert Avera, Shannon Penfound, Adam Overberg, Kristine Nañagas

Introduction: Physostigmine fell out of widespread use in the 1980s due to safety concerns; however, more recent research has demonstrated that its safety profile is better than previously thought. These studies have mainly included adults. We theorized that improved safety data may lead to more acceptance. Our objectives, therefore, were to characterize current frequency of use of physostigmine in pediatric patients as well as to study adverse effect rates in a national pediatric patient population.

Methods: The National Poison Data System was queried for cases of patients aged 0-18 years that involved single-substance exposures to antimuscarinic xenobiotics that were reported to a poison center between January 1, 2000, and December 31, 2020. Cases were stratified into groups by therapy received: benzodiazepines alone, benzodiazepines and physostigmine, physostigmine alone, or no physostigmine or benzodiazepines. Patient demographics, clinical effects, and medical outcomes were analyzed.

Results: A total of 694,132 cases were reviewed, and 150,075 were included for analysis. Nearly 5% (7562/150,075) of patients received specific pharmacological therapy with benzodiazepines, physostigmine, or both. A benzodiazepine as a single agent was the most frequently used pharmacologic therapy (92% of 7562). Among patients receiving any pharmacological therapy, only 8.3% (n = 627) of patients received physostigmine. Frequency of serious outcomes significantly increased across the study period among patients receiving benzodiazepines alone or with physostigmine. There was no increase in serious outcomes among patients receiving only physostigmine.

Conclusions: Physostigmine frequency of use was low overall, but when used, was associated with less severe outcomes when compared to benzodiazepines.

简介:上世纪 80 年代,由于安全性问题, Physostigmine 不再被广泛使用;不过,最近的研究表明,其安全性比以前想象的要好。这些研究主要涉及成年人。我们推测,安全性数据的改善可能会让更多人接受它。因此,我们的目标是了解目前儿科患者使用波司的明的频率,并研究全国儿科患者的不良反应率:方法:我们从全国毒物数据系统中查询了 2000 年 1 月 1 日至 2020 年 12 月 31 日期间向毒物中心报告的 0-18 岁患者单次接触抗马司卡因类异生物体的病例。根据所接受的治疗将病例分为以下几组:单独使用苯二氮卓类药物、苯二氮卓类药物和波司的明、单独使用波司的明或不使用波司的明或苯二氮卓类药物。对患者的人口统计学特征、临床效果和医疗结果进行了分析:共审查了 694 132 个病例,其中 150 075 个病例被纳入分析范围。近 5%(7562/150,075 例)的患者接受了苯二氮卓、扑斯的明或两者兼用的特定药物治疗。苯二氮卓类药物是最常用的药物疗法(7562 人中占 92%)。在接受任何药物治疗的患者中,只有 8.3% 的患者(n = 627)接受了波司的明治疗。在整个研究期间,单独使用苯二氮卓类药物或同时使用波司替明的患者出现严重后果的频率明显增加。结论:在研究期间,仅使用苯二氮卓类药物或同时使用芬戈斯的明的患者中,出现严重后果的频率没有增加:结论:总体而言,使用菲泊斯的明的频率较低,但与苯二氮卓类药物相比,使用菲泊斯的明导致的严重后果较少。
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引用次数: 0
American College of Medical Toxicology Research Agenda 2024-2030. 美国医学毒理学学院 2024-2030 年研究议程。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-04 DOI: 10.1007/s13181-024-01014-z
Neeraj Chhabra, Alison Meyn, Maryann Mazer-Amirshahi, Stephanie P Carreiro, Kevin Maskell, Marielle Brenner, David H Jang, Mark B Mycyk, Paul Wax

ACMT recognizes the pivotal role of high-quality research in advancing medical science. As such, the establishment of a formal research agenda for ACMT is a leap forward in communicating the priorities of the College, its members, and the patient populations we serve. This thoughtfully crafted agenda will serve as a strategic compass for ACMT, guiding our pursuit of scientific discovery, fostering innovation, and enhancing outcomes for patients and communities affected by poisonings and exposures.

ACMT 认识到高质量的研究在推动医学科学发展中的关键作用。因此,为 ACMT 制定正式的研究议程是在传达学院、成员和我们所服务的患者群体的优先事项方面的一次飞跃。这份经过深思熟虑制定的议程将成为 ACMT 的战略指南针,指导我们追求科学发现、促进创新,并为受中毒和接触影响的患者和社区提高疗效。
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引用次数: 0
In Response to "Comment on Ensuring the Efficacy and Safety of Approved Medications". 回应 "关于确保已批准药物的疗效和安全性的评论"。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-03 DOI: 10.1007/s13181-024-01006-z
Maryann Mazer-Amirshahi, Jon B Cole, Andrew I Stolbach, Jeanmarie Perrone, Lewis S Nelson
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引用次数: 0
Is EGD Needed in all Patients after Suicidal or Exploratory Caustic Ingestions? 自杀性或探查性摄入腐蚀性物质后,是否所有患者都需要做胃肠造影?
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-04-22 DOI: 10.1007/s13181-024-01003-2
Michael Levine, Yaron Finkelstein, William J Trautman, Dazhe Cao, Evan Schwarz, Ari Filip, Leanne Cook, Sameer Arbussattar Pathan, Cherie Obilom, Jim Liu, Joseph Yanta, Neta Cohen, Stephen H Thomas

Background: Caustic ingestions are relatively uncommon, but remain a significant source of morbidity. Patients with caustic injury often undergo an urgent EGD, although it is not clear if an EGD is routinely needed in an asymptomatic patient. The study has two primary objectives; 1) to determine the utility of routine EGD in asymptomatic suicidal caustic ingestions; 2) to determine if asymptomatic unintentional acidic ingestions can be managed with observation alone, similar to basic ingestions.

Methods: This retrospective study, which took place at 14 hospitals in three countries evaluated all patients who presented with a caustic ingestion between 2014-2020. The presence of symptoms and esophageal injury, demographic information, pH of ingested substance, reason for the ingestion, and outcome were recorded.

Results: 409 patients were identified; 203 (46.9%) were male. The median (IQR) age was 18 (4-31) years; overall range 10 months to 78 years. Suicidal ingestions accounted for 155 (37.9%) of cases. Dysphagia or dysphonia were more likely in those with significant esophageal injury compared to those without (59.3% vs. 12.6% respectively; OR 10.1; 95% CI 4.43-23.1). Among 27 patients with significant esophageal injury, 48% were found in suicidal patients, compared with 51.9% in non-suicidal patients (p = NS). On multivariate regression, there was no difference in the rate of significant esophageal injury among suicidal vs. non suicidal patients (aOR 1.55; p = 0.45, 95% CI 0.45-5.33). Most ingestions involved basic substances (332/409; 81.2%). Unknown or mixed ingestions accounted for 25 (6.11%) of the ingestions. Significant esophageal burns were found in 6/52 (11.5%) of acid ingestions, compared with 21/332 (6.3%) of basic ingestions. Of the 42 cases of acidic ingestions without dysphagia or odynophagia, 2 (4.8%; 0.58-16.1%) had significant esophageal burns, compared with 9 (3.2%; 95% CI 1.4-5.9%) of the 284 basic ingestions; p = 0.64). On multivariate logistic regression, patients with acidic ingestions were not more likely to experience a significant burn (aOR 1.7; p = 0.11, 95% CI 0.9-3.1) compared to those with basic ingestions. No patient with significant esophageal burns was asymptomatic.

Conclusion: In this study, there was no statistical differences in the rates of significant burns between acidic and basic caustic ingestions. There were no significant esophageal injuries noted among asymptomatic patients.

背景:腐蚀性物质摄入相对来说并不常见,但仍然是一个重要的发病原因。腐蚀性物质损伤患者通常会紧急接受胃肠道造影检查,但无症状患者是否需要常规接受胃肠道造影检查尚不清楚。本研究有两个主要目标:1)确定常规胃肠道造影术对无症状自杀性腐蚀性物质摄入的效用;2)确定无症状无意摄入酸性物质是否可以像基本摄入一样仅通过观察来处理:这项回顾性研究在三个国家的 14 家医院进行,评估了 2014-2020 年间所有因摄入腐蚀性物质而就诊的患者。研究记录了患者的症状和食道损伤、人口统计学信息、摄入物质的 pH 值、摄入原因和结果:结果:共发现 409 名患者,其中 203 名(46.9%)为男性。年龄中位数(IQR)为18(4-31)岁;总体年龄范围为10个月至78岁。自杀性摄食占 155 例(37.9%)。与无明显食管损伤的患者相比,有明显食管损伤的患者更容易出现吞咽困难或发音障碍(分别为 59.3% 对 12.6%;OR 10.1;95% CI 4.43-23.1)。在 27 名食管有明显损伤的患者中,自杀患者占 48%,而非自杀患者占 51.9%(P = NS)。多变量回归结果显示,自杀与非自杀患者的食管明显损伤率没有差异(aOR 1.55;p = 0.45,95% CI 0.45-5.33)。大多数摄入物涉及基本物质(332/409;81.2%)。未知或混合摄入占 25 例(6.11%)。6/52(11.5%)例摄入酸性物质后发现食管严重灼伤,而21/332(6.3%)例摄入碱性物质后发现食管严重灼伤。在 42 例无吞咽困难或吞咽困难的酸性食入病例中,有 2 例(4.8%;0.58-16.1%)有明显的食管灼伤,而在 284 例基本食入病例中,有 9 例(3.2%;95% CI 1.4-5.9%)有明显的食管灼伤;P = 0.64)。在多变量逻辑回归中,与基本型食道摄入相比,酸性食道摄入患者发生严重灼伤的可能性并不大(aOR 1.7;p = 0.11,95% CI 0.9-3.1)。没有食道严重烧伤患者没有症状:在这项研究中,酸性和碱性腐蚀剂摄入造成的严重灼伤率没有统计学差异。无症状患者的食管没有明显损伤。
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引用次数: 0
From Patient Registry to Multi-Center Research Consortium: the Toxicology Investigators Consortium (ToxIC) Turns Fifteen. 从患者登记处到多中心研究联盟:毒理学研究者联盟 (ToxIC) 十五岁了。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 10.1007/s13181-024-01020-1
Jeffrey Brent, Paul Wax, Rachel Culbreth, Sharan Campleman, Kim Aldy

The Toxicology Investigators Consortium (ToxIC) was launched as a prospective multi-center registry of cases who receive medical toxicology consultations. Now, with over 100,000 cases, the Core Registry continues to address many medical toxicology research questions and has served as the foundation for multiple sub-registries, including the North American Snakebite Registry and the Medications for Opioid Use Disorder sub-registry. ToxIC also has evolved a portfolio of non-registry-based projects utilizing medical toxicology physician site principal investigators who enroll patients through emergency departments, irrespective of whether they received a medical toxicology consultation. These studies include the FDA-ACMT COVID-19 ToxIC Pharmacovigilance Project, which identifies adverse drug reactions related to the treatment of COVID-19, the Fentalog Study a toxico-surveillance study of suspected opioid overdose cases, the Drug Overdose Toxico-Surveillance Reporting Program which enrolls either suspected stimulant or opioid overdose cases, and the just being launched Real-World Examination of Naloxone for Drug Overdose Reversal project. Given ToxIC's experience in multi-center studies and its well-developed infrastructure, it is well-positioned to provide a nimble response on the part of the medical toxicology community to addressing evolving toxicological threats, drug and chemical toxicosurveillance, and other important medical toxicology priorities.

毒理学研究者联盟 (ToxIC) 是作为接受医学毒理学咨询的病例的前瞻性多中心登记处而启动的。现在,核心注册中心已拥有超过 100,000 个病例,继续解决许多医学毒理学研究问题,并为多个子注册中心奠定了基础,其中包括北美蛇咬伤注册中心和阿片类药物使用障碍子注册中心。ToxIC 还发展了一系列非注册项目,这些项目利用医学毒理学医生站点的主要研究人员,通过急诊科招募患者,无论他们是否接受过医学毒理学咨询。这些研究包括:FDA-ACMT COVID-19 ToxIC 药物警戒项目(该项目用于识别与 COVID-19 治疗相关的药物不良反应)、Fentalog 研究(一项针对疑似阿片类药物过量病例的毒理监测研究)、药物过量毒理监测报告项目(该项目招募疑似兴奋剂或阿片类药物过量病例),以及刚刚启动的纳洛酮用于药物过量逆转的真实世界检验项目。鉴于 ToxIC 在多中心研究方面的经验及其完善的基础设施,它完全有能力为医学毒理学界提供灵活的应对措施,以应对不断变化的毒理学威胁、药物和化学毒物监测以及其他重要的医学毒理学优先事项。
{"title":"From Patient Registry to Multi-Center Research Consortium: the Toxicology Investigators Consortium (ToxIC) Turns Fifteen.","authors":"Jeffrey Brent, Paul Wax, Rachel Culbreth, Sharan Campleman, Kim Aldy","doi":"10.1007/s13181-024-01020-1","DOIUrl":"10.1007/s13181-024-01020-1","url":null,"abstract":"<p><p>The Toxicology Investigators Consortium (ToxIC) was launched as a prospective multi-center registry of cases who receive medical toxicology consultations. Now, with over 100,000 cases, the Core Registry continues to address many medical toxicology research questions and has served as the foundation for multiple sub-registries, including the North American Snakebite Registry and the Medications for Opioid Use Disorder sub-registry. ToxIC also has evolved a portfolio of non-registry-based projects utilizing medical toxicology physician site principal investigators who enroll patients through emergency departments, irrespective of whether they received a medical toxicology consultation. These studies include the FDA-ACMT COVID-19 ToxIC Pharmacovigilance Project, which identifies adverse drug reactions related to the treatment of COVID-19, the Fentalog Study a toxico-surveillance study of suspected opioid overdose cases, the Drug Overdose Toxico-Surveillance Reporting Program which enrolls either suspected stimulant or opioid overdose cases, and the just being launched Real-World Examination of Naloxone for Drug Overdose Reversal project. Given ToxIC's experience in multi-center studies and its well-developed infrastructure, it is well-positioned to provide a nimble response on the part of the medical toxicology community to addressing evolving toxicological threats, drug and chemical toxicosurveillance, and other important medical toxicology priorities.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neonatal and Maternal Ichthyosiform Dermopathy in Association with Kava Use during Pregnancy. 新生儿和产妇鱼鳞状皮肤病与孕期使用卡瓦有关。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1007/s13181-024-01016-x
Hannah H Spungen, Kartik Mody, Becky Micetic, Christine Wade, A Min Kang

Introduction: Kava, a substance derived from the Piper methysticum plant, is enjoying a surge in popularity in the United States due to its purported anxiolytic and analgesic effects. Though ichthyosiform dermopathy is a known adverse effect associated with chronic kava exposure in adults, dermopathy in a newborn due to maternal kava use has not yet been described.

Case report: This is a case of a 41-year-old woman who was taking a combination kava/kratom product throughout her pregnancy. She developed an ichthyosiform dermopathy that resolved after she stopped using the product postpartum. Her male infant had a neonatal course complicated by both neonatal opioid withdrawal syndrome, attributed to maternal kratom and buprenorphine use, as well as a diffuse ichthyosiform rash similar to descriptions of kava ichthyosiform dermopathy in adults. His neonatal course was complicated by Group B streptococcus and Serratia marscecens bacteremia (treated with antibiotics) and seizures (treated with lorazepam and phenobarbital). His rash resolved completely by day of life 22. At 9-month outpatient follow-up, he had no dermatologic abnormalities or rash recurrence.

Discussion: Maternal kava use during pregnancy may cause fetal dermopathy presenting as an acquired ichthyosis. More public education is needed about the potential consequences of kava use, particularly during pregnancy.

导言:卡瓦是从Piper methysticum植物中提炼出来的一种物质,由于据称具有抗焦虑和镇痛作用,因此在美国大受欢迎。虽然鱼鳞状皮肤病是一种已知的与成人长期接触卡瓦有关的不良反应,但因母亲使用卡瓦而导致新生儿皮肤病的病例尚未见报道:这是一个 41 岁女性的病例,她在整个孕期服用卡瓦/桔梗复合产品。产后停止使用该产品后,她患上了鱼鳞状皮肤病。她的男婴在新生儿期并发了新生儿阿片类药物戒断综合征(归因于母体使用了克拉托姆和丁丙诺啡)和弥漫性鱼鳞状皮疹,与成人卡瓦鱼鳞状皮病的描述相似。B 组链球菌和沙雷氏菌引起的菌血症(抗生素治疗)和癫痫发作(劳拉西泮和苯巴比妥治疗)使他的新生儿病程变得复杂。他的皮疹在出生后第 22 天完全消退。在 9 个月的门诊随访中,他没有出现皮肤异常或皮疹复发:讨论:母亲在怀孕期间使用卡瓦可能会导致胎儿皮肤病,表现为获得性鱼鳞病。需要对公众进行更多的教育,让他们了解使用卡瓦的潜在后果,尤其是在怀孕期间。
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引用次数: 0
Case Files from the University of California San Diego Medical Toxicology Fellowship: Neonatal Flecainide Toxicity from an Accidental Dosing Error. 加州大学圣地亚哥分校医学毒理学研究员的病例档案:意外剂量错误导致的新生儿弗来凯尼中毒。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-11 DOI: 10.1007/s13181-024-01018-9
Justin Seltzer, Aaron Schneir
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引用次数: 0
The American College of Medical Toxicology (ACMT) Commitment to Diversity, Equity, and Inclusion in Medical Toxicology. 美国医学毒理学学院 (ACMT) 对医学毒理学多样性、公平性和包容性的承诺。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-08 DOI: 10.1007/s13181-024-01021-0
Peter D Akpunonu, Richard J Church, Kavita M Babu, Trevonne M Thompson
{"title":"The American College of Medical Toxicology (ACMT) Commitment to Diversity, Equity, and Inclusion in Medical Toxicology.","authors":"Peter D Akpunonu, Richard J Church, Kavita M Babu, Trevonne M Thompson","doi":"10.1007/s13181-024-01021-0","DOIUrl":"10.1007/s13181-024-01021-0","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ACMT Comment on Recent Guidance on PFAS Laboratory Testing. ACMT 就 PFAS 实验室测试最新指南发表评论。
IF 2.5 4区 医学 Q3 TOXICOLOGY Pub Date : 2024-09-01 Epub Date: 2024-04-18 DOI: 10.1007/s13181-024-01004-1
John W Downs, Nicholas E Nacca, Andrew I Stolbach, Michael G Holland
{"title":"ACMT Comment on Recent Guidance on PFAS Laboratory Testing.","authors":"John W Downs, Nicholas E Nacca, Andrew I Stolbach, Michael G Holland","doi":"10.1007/s13181-024-01004-1","DOIUrl":"10.1007/s13181-024-01004-1","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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