Clinical presentation, outcome and management of snakebite cases in Saudi Arabia.

Background: Snakebite envenomation remains a significant public health concern in Asir Province of Saudi Arabia.

Aim: To characterize snake species and the clinical presentation, outcome and management of snakebite cases admitted to 4 major hospitals in Asir Province, Saudi Arabia .

Methods: This retrospective study reviewed medical records of paediatric and adult snakebite cases admitted to 4 regional hospitals in Saudi Arabia between January 2000 and December 2021 using search terms "snakebite", "cobra", "polyvalent antivenin", "antivenom", "compartment syndrome", and "fasciotomy".

Predictors of prolonged supratherapeutic serum lithium concentrations: a retrospective chart review.

Introduction: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup suggests hemodialysis in severe lithium poisoning if specific criteria are met. One criterion is if the expected time to obtain a lithium concentration <1.0 mEq/L with optimal management is >36 h.

Oral potassium poisoning: a retrospective review of the National Poison Data System 2010-2021.

Introduction: Oral potassium poisoning can be life-threatening. The study aimed to describe patterns of oral potassium poisoning in adult and pediatric populations and characterize its clinical presentation and management as reported by United States poison centers.

Methods: This is a retrospective review of the National Poison Data System from 1 January 2010 through 30 June 2021.

Access to, Experience with, and Attitudes towards Take Home Naloxone: An Online Survey.

The opioid public health crisis continues to burden individuals, communities, and economies. Public health opinion has emphasized the need for increased access to harm reduction services, but there is a dearth of information on the views and experiences of people who use opioids. Our study aimed to investigate the prevalence of naloxone use, attitudes, and experiences with naloxone among an online community of people who use drugs.

poisoning: identification of steroidal alkaloids in patient blood and breast milk.

Introduction: The genus is composed of plants containing a diverse set of steroidal alkaloids. plant material has been utilized for centuries as herbal medicines, however the alkaloids have such a low therapeutic index that they are not used in modern medicine. Here we report an incident of inadvertent ingestion of by hikers in Georgia that allowed detection, and in several instances identification of alkaloids from the plant, and correlated their presence within patient blood and breast milk specimens.

Two Cases of Severe Amanita Muscaria Poisoning Including a Fatality.

Ingestion of Amanita muscaria mushrooms results in transient central nervous system excitation and depression mediated by its components, ibotenic acid and muscimol. The mushroom is distributed worldwide and ingestions occur with some frequency. Although these ingestions have traditionally been considered benign, serious complications can occur.

Elevated methemoglobin levels in patients treated with hydroxocobalamin: a case series and analysis.

Background: Historically, the first step in treating cyanide (CN) toxicity utilized antidotes to induce methemoglobinemia. This is concerning in patients who are already hypoxemic or have elevated carboxyhemoglobin. Hydroxocobalamin (OHCbl) is now the first-line antidote for CN toxicity and is not known to induce methemoglobinemia.

Telephonic Medical Toxicology Service in a Low-Resource Setting: Setup, Challenges, and Opportunities.

Poisoning and envenomation are a global health problem for which the mortality burden is shouldered heavily by middle- and low-income countries that often lack poison prevention programs and medical toxicology expertise. Although telehealth or teleconsult services have been used to bridge the expertise gap between countries for multiple specialties, the use of medical toxicology teleconsult services across borders has been limited. We aim to describe the use of a United States-based medical toxicology teleconsult service to support patient care at a hospital in a middle-income country that lacks this expertise.

Toxicological exposures among the pediatric patients at a tertiary care center in Lebanon: the case for establishing a national poison center.

Background: Despite its preventable nature, poisoning remains one of the leading causes of morbidity and mortality in the pediatric population. In Lebanon, this population is poorly studied and there is no poison center to which healthcare providers and the public can refer in case of toxicological exposure, leading to unnecessary Emergency Department (ED) visits. This study describes the pediatric toxicological exposures seen at the largest tertiary care center in Lebanon.

Elevated Methemoglobin Levels in a Patient Treated with Hydroxocobalamin After Suspected Cyanide Exposure.

Background: Cyanide (CN) toxicity commonly occurs during enclosed-space fires. Historically, the first step in treating CN toxicity utilized amyl nitrite and sodium nitrite to induce methemoglobinemia, which can be dangerous in this population. Hydroxocobalamin (OHCob), which binds to CN to form the nontoxic metabolite cyanocobalamin, is now the first-line antidote for CN toxicity, and has the advantage of not inducing methemoglobinemia.

Circumstances Involved in Unsupervised Solid Dose Medication Exposures among Young Children.

Objective: To identify types of containers from which young children accessed solid dose medications (SDMs) during unsupervised medication exposures and the intended recipients of the medications to advance prevention.

Study Design: From February to September 2017, 5 US poison centers enrolled individuals calling about unsupervised solid dose medication exposures by children ≤5 years. Study participants answered contextually directed questions about exposure circumstances.

Toxicological exposures reported to a telephonic consultation service at a tertiary care hospital in Lebanon.

This study aims to describe the epidemiology of toxicological exposures reported to a telephonic medical toxicology service at a tertiary care center in Lebanon during a 46-months period. This study is a secondary analysis of a database for a telephonic medical toxicology service at a tertiary care center in Lebanon. Clinical information from all pediatric and adult patients, presenting with intentional or unintentional toxicological exposure, was entered into the database by the medical toxicology team.

Naloxone Dosing After Opioid Overdose in the Era of Illicitly Manufactured Fentanyl.

Introduction: Illicitly manufactured fentanyl (IMF) is responsible for a growing number of deaths. Some case series have suggested that IMF overdoses require significantly higher naloxone doses than heroin overdoses. Our objective was to determine if the naloxone dose required to treat an opioid overdose is associated with the finding of fentanyl, opiates, or both on urine drug screen (UDS).

Does Lidocaine Cause False Positive Results on Cocaine Urine Drug Screen?

Background: Individuals who have tested positive for cocaine have claimed that lidocaine, or its primary metabolite, norlidocaine (monoethylglycinexylidide (MEGX)), have caused false positive results for the cocaine metabolite benzoylecgonine (BE) on urinary immunoassay testing.

Objective: The goal of the study was to determine if lidocaine exposure from routine medical procedures can result in false positives on a commercially available cocaine immunoassay urine drug screen (UDS).

Methods: We performed a cross-sectional observational study of patients receiving lidocaine as part of their regular care.

Retrospective Review of a Novel Approach to Buprenorphine Induction in the Emergency Department.

Background: The Emergency Department (ED) frequently treats patients with drug overdoses and is an important resource for individuals with opioid use disorder who are seeking treatment. Initiating medication-assisted treatment (MAT) in the ED seems to be an effective way to link patients with opioid use disorder (OUD) to treatment programs. There is ongoing discussion on the best approach to MAT in the ED setting.

ElectronixTutor: an intelligent tutoring system with multiple learning resources for electronics.

Background: The Office of Naval Research (ONR) organized a STEM Challenge initiative to explore how intelligent tutoring systems (ITSs) can be developed in a reasonable amount of time to help students learn STEM topics. This competitive initiative sponsored four teams that separately developed systems that covered topics in mathematics, electronics, and dynamical systems. After the teams shared their progress at the conclusion of an 18-month period, the ONR decided to fund a joint applied project in the Navy that integrated those systems on the subject matter of electronic circuits.

Unintentional trazodone overdoses in children ≤6 years of age: data from poison center over a period of 16 years.

Context: Trazodone is an atypical antidepressant with no established safety in children. Previous case reports showed no complications at doses 50-500 mg in children. Our study objective is to characterize the clinical effects, dose-related toxicity, and establish triage dose for acute trazodone ingestions in children ≤6 years of age.

Elevated lead level from a tobacco source requiring chelation in a 12-year-old child.

Context: Across the world, tobacco is used in a variety of forms, including being smoked or added to a "quid" that is then chewed. We report a case of lead poisoning in a child from tobacco imported from Thailand.

Case Details: A 12-year-old Thai immigrant boy had a blood lead level (BLL) of 6 mcg/dL on routine testing upon arrival to the United States, but which increased to 72 mcg/dL six months after his arrival.

Hikers poisoned: Veratrum steroidal alkaloid toxicity following ingestion of foraged Veratrum parviflorum.

Introduction: Steroidal alkaloids are found in plants of the genus Veratrum. Their toxicity manifests as gastrointestinal symptoms followed by a Bezold-Jarisch reflex: hypopnea, hypotension, and bradycardia. Some Veratrum steroidal alkaloids are also teratogens interfering with the hedgehog-2 signaling pathway, which causes cyclopsia and holoprosencephaly.

The epidemiology, prognosis, and trends of severe traumatic brain injury with presenting Glasgow Coma Scale of 3.

Purpose: To characterize trends and prognosis of severe traumatic brain injury (TBI).

Methods: This 5-year multicenter retrospective study included patients with TBI and Glasgow Coma Scale of 3. We analyzed demographic and clinical characteristics and mortality using Pearson χ tests, Cochran-Armitage trend tests, and stepwise logistic regression.

The successful treatment of 5-fluorouracil (5-FU) overdose in a patient with malignancy and HIV/AIDS with uridine triacetate.

According to the NIH, about 275000 patients receive treatment with 5-Fluorouracil (5-FU) and more than 1300 die from 5-FU toxicity every year from life-threatening myelosuppression, gastrointestinal complications, and neurotoxicity. Immunocompromised persons are at higher risk of developing toxicity. Recently uridine triacetate (Vistagard®) has been approved by the Food and Drug Administration (FDA) as the only specific antidote available for 5-FU poisoning.

The influence of positive vs. negative affect on multitasking.

Considerable research has investigated how affect influences performance on a single task; however, little is known about the role of affect in complex multitasking environments. In this paper, 178 participants multitasked in a synthetic work environment (SYNWORK) consisting of memory, visual monitoring, auditory monitoring, and math tasks. Participants multitasked for a 3-min baseline phase (MT1), following which they were randomly assigned to watch one of three affect-induction videos: positive, neutral, or negative.

Pilot Study of the Importance of Factors Affecting Emergency Department Opioid Analgesic Prescribing Decisions.

Introduction: Little is known about the factors driving decision-making among emergency department (ED) providers when prescribing opioid analgesics (OA). The aim of this pilot study was to identify the importance of factors influencing OA-prescribing decisions and to determine how this varied among different types of providers.

Methods: This was an observational cross-sectional survey study of 203 ED providers.