Chemical submission to commit robbery: a series of involuntary intoxications with flunitrazepam in Asian travellers in Brussels.

Between January 17, 2003 and August 29, 2003, the Emergency Department admitted a patient who had been surreptitiously intoxicated and robbed of his valuables every Friday. The first cases were considered anecdotal, but criminal activity was rapidly suspected. The cohort includes 16 male Asian patients aged 28-50 years.

A 'shock room' for early management of the acutely ill.

Our 850-bed, academic, tertiary care hospital uses a four-bed dedicated 'shock room' situated between the Departments of Emergency Medicine and Intensive Care to stabilise all acutely ill patients from outside or inside the hospital before transfer to the intensive care unit or other department. Admitted patients stay a maximum of four hours in the shock room. In this article we describe our experiences using this shock room by detailing the demographic data, including time and source of admission, diagnosis and outcome, for the 2514 patients admitted to the shock room in 2006.

Carnitine in the treatment of valproic acid-induced toxicity.

Introduction: Valproic acid (VPA) is a broad-spectrum antiepileptic drug that is now used commonly for several other neurological and psychiatric indications. VPA is usually well tolerated, but serious complications, including hepatotoxicity and hyperammonemic encephalopathy, may occur. These complications may also arise following acute VPA overdose, the incidence of which is increasing.

Epigastric pain as presentation of an addisonian crisis in a patient with Schmidt syndrome.

A 39-year-old woman presented with a 10-day history of epigastric pain accompanied by persistent fatigue and loss of appetite for 3 months. She had presented several weeks earlier with adhesive capsulitis, treated by local infiltration of corticosteroids. She was not taking any other medications.

Seroprotection against tetanus in patients attending an emergency department in Belgium and evaluation of a bedside immunotest.

Background: In most emergency departments, tetanus prophylaxis currently relies on vaccination history. Bedside evaluation of tetanus immunity may improve this process.

Objectives: (i) To determine the seroprevalence of tetanus immunity; (ii) to evaluate the accuracy of vaccination history in assessing tetanus immunity; (iii) to identify factors predictive of seroprotection and incorrect history.

Assessment of pretest probability of pulmonary embolism in the emergency department by physicians in training using the Wells model.

Introduction: Assessment of pretest probability should be the initial step in investigation of patients with suspected pulmonary embolism (PE). In teaching hospitals physicians in training are often the first physicians to evaluate patients.

Objective: To evaluate the accuracy of pretest probability assessment of PE by physicians in training using the Wells clinical model and to assess the safety of a diagnostic strategy including pretest probability assessment.

Bench-to-bedside review: hyperinsulinaemia/euglycaemia therapy in the management of overdose of calcium-channel blockers.

Hyperinsulinaemia/euglycaemia therapy (HIET) consists of the infusion of high-dose regular insulin (usually 0.5 to 1 IU/kg per hour) combined with glucose to maintain euglycaemia. HIET has been proposed as an adjunctive approach in the management of overdose of calcium-channel blockers (CCBs).

Collaborative filtering on a family of biological targets.

Building a QSAR model of a new biological target for which few screening data are available is a statistical challenge. However, the new target may be part of a bigger family, for which we have more screening data. Collaborative filtering or, more generally, multi-task learning, is a machine learning approach that improves the generalization performance of an algorithm by using information from related tasks as an inductive bias.

Bench-to-bedside review: Antidotal treatment of sulfonylurea-induced hypoglycaemia with octreotide.

The major potential adverse effect of use of sulfonylurea agents (SUAs) is a hyperinsulinaemic state that causes hypoglycaemia. It may be observed during chronic therapeutic dosing, even with very low doses of a SUA, and especially in older patients. It may also result from accidental or intentional poisoning in both diabetic and nondiabetic patients.

Science review: carnitine in the treatment of valproic acid-induced toxicity - what is the evidence?

Valproic acid (VPA) is a broad-spectrum antiepileptic drug and is usually well tolerated, but rare serious complications may occur in some patients receiving VPA chronically, including haemorrhagic pancreatitis, bone marrow suppression, VPA-induced hepatotoxicity (VHT) and VPA-induced hyperammonaemic encephalopathy (VHE). Some data suggest that VHT and VHE may be promoted by carnitine deficiency. Acute VPA intoxication also occurs as a consequence of intentional or accidental overdose and its incidence is increasing, because of use of VPA in psychiatric disorders.

Selective small molecule peptidomimetic ligands of TrkC and TrkA receptors afford discrete or complete neurotrophic activities.

We designed a minilibrary of 55 small molecule peptidomimetics based on beta-turns of the neurotrophin growth factor polypeptides neurotrophin-3 (NT-3) and nerve growth factor (NGF). Direct binding, binding competition, and biological screens identified agonistic ligands of the ectodomain of the neurotrophin receptors TrkC and TrkA. Agonism is intrinsic to the peptidomimetic ligand (in the absence of neurotrophins), and/or can also be detected as potentiation of neurotrophin action.

Pyridoxine in clinical toxicology: a review.

Pyridoxine (vitamin B6) is a co-factor in many enzymatic pathways involved in amino acid metabolism: the main biologically active form is pyridoxal 5-phosphate. Pyridoxine has been used as an antidote in acute intoxications, including isoniazid overdose, Gyromitra mushroom or false morrel (monomethylhydrazine) poisoning and hydrazine exposure. It is also recommended as a co-factor to improve the conversion of glyoxylic acid into glycine in ethylene glycol poisoning.

Management of new-onset atrial fibrillation in the emergency department: is there any predictive factor for early successful cardioversion?

Objectives: The aim of this retrospective study was to assess the initial management of atrial fibrillation (AF) in the emergency department (ED) and to identify predictive factors of early conversion to sinus rhythm, which could justify a short stay in the ED observation unit (EDOU) instead of longer hospitalization.

Patients And Methods: All patients with acute AF, either of new onset or recurrent, admitted to our hospital during a 12-month period were included in the study. Hospital records were reviewed retrospectively.

Locally linear embedding for dimensionality reduction in QSAR.

Current practice in Quantitative Structure Activity Relationship (QSAR) methods usually involves generating a great number of chemical descriptors and then cutting them back with variable selection techniques. Variable selection is an effective method to reduce the dimensionality but may discard some valuable information. This paper introduces Locally Linear Embedding (LLE), a local non-linear dimensionality reduction technique, that can statistically discover a low-dimensional representation of the chemical data.

[Ototoxicity-related dysequilibrium].

Many substances may be the source of dizziness or transient equilibrium disturbances due to dysfunction of the CNS or to an impairment of visual or proprioceptive informations. Other agents are responsible for drop of arterial pressure by changing position, including antihypertensive drugs, alpha-blocking agents used in urology, antipsychotics, cyclic antidepressants, vasodilators and nitrates, dopaminergic antiparkinson drugs, sedatives, etc. Only drug with true ototoxic properties will be discussed here, namely substances that are able to damage the inner ear (cochlear or vestibular damage) or the VIIIth cranial nerve, causing impairment of equilibrium and/or (most often) hearing.

Biased fragment distribution in MC simulation of protein folding.

Monte Carlo (MC) methods play an important role in simulations of protein folding. These methods rely on a random sampling of moves on a potential energy surface. To improve the efficiency of the sampling, we propose a new selection of trial moves based on an empirical distribution of three-residue (triplet) conformations.

[The emergency department].

After a brief history of Emergency Departments in Belgium, the evolution of the clinical activity and the main research topics developed in Erasme Hospital are developed, including the management of the department and of patients flows, and acute clinical toxicology.

[Serotonin syndrome].

The serotonin syndrome is a hyperserotoninergic state resulting from an excess of intrasynaptic 5-hydroxytryptamine, induced by multiple psychotropic agents, but also non psychiatric drugs. It is a potentially dangerous and sometimes lethal condition. The clinical manifestations usually include cognitive, neuromuscular and autonomic features and are mediated by the action of serotonin on various subtypes of receptors.

[Ototoxicity-related vertigo].

Many substances may be the source of dizziness or transient equilibrium disturbances due to dysfunction of the CNS or to an impairment of visual or proprioceptive informations. Other agents are responsible for drop of arterial pressure by changing position, including antihypertensive drugs, alpha-blocking agents used in urology, antipsychotics, cyclic antidepressants, vasodilators and nitrates, dopaminergic antiparkinson drugs, sedatives, etc. Only drug with true ototoxic properties will be discussed here, namely substances that are able to damage the inner ear (cochlear or vestibular damage) or the VIIIth cranial nerve, causing impairment of equilibrium and/or (most often) hearing.

Survey of non-invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease patients in emergency departments in Belgium.

A study was undertaken to assess the availability and use of non-invasive ventilation (NIV) for the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) in emergency departments in Belgium. A questionnaire was sent to the head physicians of 145 emergency departments (EDs) found in the list of the Belgian College of Emergency Physicians (BeCEP). Ninety eight questionnaires were analysed (representing 68% of the questionnaires sent).