Variation of drugs involved in acute drug toxicity presentations based on age and sex: an epidemiological approach based on European emergency departments.

Objective: To analyse the relative percentage of acute recreational drug toxicity emergency department (ED) presentations involving the main drug groups according to age and sex and investigate different patterns based on sex and age strata.

Methods: We analysed all patients with acute recreational drug toxicity included by the Euro-DEN Plus dataset (22 EDs in 14 European countries) between October 2013 and December 2016 (39 months). Drugs were grouped as: opioids, cocaine, cannabis, amphetamines, gamma-hydroxybutyrate (GHB), hallucinogens, new psychoactive substances (NPS), benzodiazepines and ketamine.

Literature review of the evidence regarding intravenous lipid administration in drug-induced cardiotoxicity.

: Intravenous lipid emulsion (ILE) administration is capable of reversing the acute cardiac and neurological toxicity caused by local anesthetic agents. In recent years, ILE has also been explored as a potential antidote for cardiotoxicity caused by non-anesthetic agents too. : The potential mechanisms, safety, and efficacy of this approach are considered.

Bibliometric profile of global scientific research on digoxin toxicity (1849-2015).

Digoxin is a cardiac glycoside derived from the common foxglove and has been available for several centuries as a medicinal agent. Despite extensive patient experience over many years, there remains some controversy regarding the possibility that digoxin might have a deleterious effect on survival. This study was constructed to assess trends in digoxin toxicity research using well-established qualitative and quantitative bibliometric indicators.

Acute visual loss in a patient with spinal cord injury.

Introduction: Patients with spinal cord injury (SCI), especially those with injury at and above T6, are prone to transient episodes of hypertension induced by noxious triggers below the level of SCI, known as autonomic dysreflexia (AD). An uncommonly reported presentation of AD is posterior reversible encephalopathy syndrome (PRES).

Case Presentation: A 50-year-old male with the history of paraplegia from SCI presented with sepsis secondary to baclofen pump and urinary tract infections.

Pneumomediastinum as a complication of MDMA (3,4-methylenedioxymetamfetamine, Ecstasy) ingestion.

MDMA (3,4-methylenedioxymethamfetamine, Ecstasy) is a widely used recreational drug. We present a case of pneumomediastinum as a complication of MDMA use in a 21-year-old man with no previous history of lung or gastrointestinal pathology. We have performed a literature review, and summarised the symptoms, signs, and prognosis for this under-recognised complication of a commonly used recreational drug.

Updates for the International Standards for Neurological Classification of Spinal Cord Injury.

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the most widely used classification in the field of spinal cord injury medicine. Since its first publication in 1982, multiple revisions refining the recommended examination, scaling, and classification have taken place to improve communication, consistency, and clarity. This article describes a brief historical perspective on the development and changes over the years leading to the current ISNCSCI, detailing the most recent updates of 2011 and the worksheet 2013 as well as issues facing the ISNCSCI for the future.

Transitioning adolescents and young adults with spina bifida to adult healthcare: initial findings from a model program.

Purpose: The Spina Bifida Transition Project (SBTP) was developed by partners from pediatric and adult health care settings using existing best practice information in an effort to transition adolescents to adult health care providers. The purpose of this manuscript is to present the results of an initial evaluation of the SBTP from the adolescent/young adult (AYA) and family perspective.

Design And Methods: Qualitative evaluation data were obtained from telephone interviews with 40 individuals (24 AYA and 16 parents representing 28 families) two-three weeks after initial adult clinic visits using a semi-structured interview guide.

Transitioning adolescents and young adults with a chronic health condition to adult healthcare - an exemplar program.

Pediatric specialists have successfully improved the longevity and quality of life of many children with chronic health conditions. As these children reach adolescence and young adulthood, the scope of their concomitant medical problems often include those typically seen in older patients. As a result, these individuals need continuing quality health care in focused adult healthcare facilities.

Reference for the 2011 revision of the International Standards for Neurological Classification of Spinal Cord Injury.

The latest revision of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) was available in booklet format in June 2011, and is published in this issue of the Journal of Spinal Cord Medicine. The ISNCSCI were initially developed in 1982 to provide guidelines for the consistent classification of the neurological level and extent of the injury to achieve reliable data for clinical care and research studies. This revision was generated from the Standards Committee of the American Spinal Injury Association in collaboration with the International Spinal Cord Society's Education Committee.

Protocol management of late-stage pressure ulcers: a 5-year retrospective study of 101 consecutive patients with 179 ulcers.

Background: Despite a 12 to 82 percent pressure ulcer recurrence rate, no standard protocol exists for postoperative management. The authors reviewed a single surgeon's experience using a standard protocol: surgery and immediate reconstruction regardless of nutrition, intraoperative bone culture guiding postoperative antibiotic use, and hospital admission for 3 weeks of flat bedrest before graduated sitting.

Methods: A 5-year retrospective chart review was performed on consecutive surgically treated pressure ulcers.

_ 2009 review and revisions of the international standards for the neurological classification of spinal cord injury.

The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) were recently reviewed by the ASIA's Education and Standards Committees, in collaboration with the International Spinal Cord Society's Education Committee. Available educational materials for the ISNCSCI were also reviewed. The last citable reference for the ISNCSCI's methodology is the ISNCSCI Reference Manual, published in 2003 by ASIA.

Onset and recovery of hepatic and renal injury after deliberate acute paracetamol overdose.

A 54-year-old woman presented to hospital after deliberate acute ingestion of paracetamol 20 g. Despite early administration of a standardised acetylcysteine regimen, the patient developed acute liver impairment and acute renal impairment. Prolonged acetylcysteine administration and supportive measures allowed restoration of normal liver and renal function.

Acute liver impairment after sodium valproate overdose.

Liver impairment is a recognised adverse effect of long-term sodium valproate treatment, but there are few reports concerning its occurrence after acute overdose. This report describes a 36-year-old woman who deliberately ingested 32 g of sodium valproate (Epilim). Serum valproate concentration was 4370 μmol/l (630 mg/l) at 4.

Lamotrigine overdose associated with generalised seizures.

This report describes the occurrence of generalised seizures in a 42-year-old woman who presented to hospital after deliberate lamotrigine overdose. Seizure activity was promptly terminated after intravenous benzodiazepine administration, and the patient subsequently made a complete recovery. Serum lamotrigine concentration was 30 mg/l at 1.

Acute myopathy in a patient with oesophageal stricture.

Background: Muscle injury may be caused by any one of a number of factors, including trauma, drugs, hyperthermia and metabolic derangement. Symptoms and signs are often non-specific, and myopathy may be easily overlooked.

Case: An elderly woman was referred to hospital for investigation of rapidly declining mobility in the setting of anorexia and vomiting due to benign oesophageal stricture.

Delayed cardiotoxicity in chronic lithium poisoning: discrepancy between serum lithium concentrations and clinical status.

Chronic lithium poisoning is characteristically associated with greater toxicity than acute ingestion. Neurotoxic features may occur within several hours, whereas major cardiovascular effects are typically not seen until later. This report describes profound bradycardia as a late consequence of chronic lithium poisoning, and reminds us to consider the possibility of delayed toxic effects, even in situations where serum lithium concentrations appear to be declining.