Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.180
Filtrar
1.
JMIR Res Protoc ; 13: e57367, 2024 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-39255471

RESUMEN

BACKGROUND: Opioid overdose is a global health crisis, affecting over 27 million individuals worldwide, with more than 100,000 drug overdose deaths in the United States in 2022-2023. This protocol outlines the development of the PneumoWave chest biosensor, a wearable device being designed to detect respiratory depression in real time through chest motion measurement, intending to enhance early intervention and thereby reduce fatalities. OBJECTIVE: The study aims to (1) differentiate opioid-induced respiratory depression (OIRD) from nonfatal opioid use patterns to develop and refine an overdose detection algorithm and (2) examine participants' acceptability of the chest biosensor. METHODS: The study adopts an observational design over a 6-month period. The biosensor, a small device, will be worn by consenting participants during injecting events to capture chest motion data. Safe injecting facilities (SIF) in Melbourne, Victoria (site 1), and Sydney, New South Wales (site 2), which are legally sanctioned spaces where individuals can use preobtained illicit drugs under medical supervision. Each site is anticipated to recruit up to 100 participants who inject opioids and attend the SIF. Participants will wear the biosensor during supervised injecting events at both sites. The biosensor will attempt to capture data on an anticipated 40 adverse drug events. The biosensor's ability to detect OIRD will be compared to the staff-identified events that use standard protocols for managing overdoses. Measurements will include (1) chest wall movement measured by the biosensor, securely streamed to a cloud, and analyzed to refine an overdose detection algorithm and (2) acute events or potential overdose identified by site staff. Acceptability will be measured by a feedback questionnaire as many times as the participant is willing to throughout the study. RESULTS: As of April 2024, a total of 47 participants have been enrolled and data from 1145 injecting events have already been collected, including 10 overdose events. This consists of 17 females and 30 males with an average age of 45 years. Data analysis is ongoing. CONCLUSIONS: This protocol establishes a foundation for advancing wearable technology in opioid overdose prevention within SIFs. The study will provide chest wall movement data and associated overdose data that will be used to train an algorithm that allows the biosensor to detect an overdose. The study will contribute crucial insights into OIRD, emphasizing the biosensor's potential step forward in real-time intervention strategies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57367.


Asunto(s)
Dispositivos Electrónicos Vestibles , Humanos , Masculino , Femenino , Sobredosis de Droga/diagnóstico , Sobredosis de Opiáceos/epidemiología , Sobredosis de Opiáceos/diagnóstico , Adulto , Persona de Mediana Edad , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/administración & dosificación , Técnicas Biosensibles/instrumentación , Técnicas Biosensibles/métodos , Estudios Observacionales como Asunto , Nueva Gales del Sur/epidemiología , Insuficiencia Respiratoria/diagnóstico
2.
J Assoc Physicians India ; 72(8): 96-98, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39163079

RESUMEN

This case report presents the clinical course and management of a 62-year-old female patient with atrial fibrillation (AF) secondary to levothyroxine overdose along with an underlying secondary infection. The patient was admitted with sudden onset dyspnea, altered sensorium, and neurological deficits. Upon examination, she exhibited tachycardia, irregular heart sounds, and extensive crepitations in the respiratory system. Her electrocardiogram (ECG) showed an absent P wave with a varying RR interval. Laboratory investigations revealed abnormal thyroid function tests (TFTs) and raised polymorphonuclear cells, in addition to hyperglycemia. The patient was managed in the intensive care unit (ICU) with bilevel positive airway pressure (BiPAP) and supplemental oxygen, treated for AF with intravenous (IV) amiodarone, and her blood sugar was controlled with insulin infusion. Discontinuation of levothyroxine therapy was advised. Subsequently, her AF was terminated, and sinus rhythm was restored. Her neurological examination showed right-sided hemiplegia with aphasia. After 1 week of treatment, her TFTs normalized, and she was discharged on appropriate medication.


Asunto(s)
Fibrilación Atrial , Sobredosis de Droga , Tiroxina , Humanos , Femenino , Fibrilación Atrial/tratamiento farmacológico , Persona de Mediana Edad , Tiroxina/administración & dosificación , Tiroxina/uso terapéutico , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/complicaciones , Electrocardiografía , Amiodarona/administración & dosificación , Amiodarona/efectos adversos
3.
Pediatr Emerg Care ; 40(9): 650-653, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-38950407

RESUMEN

INTRODUCTION: Adolescent overdoses have been rising over the past decade. Emergency department (ED) visits for both acute overdoses and for adolescents in opioid withdrawal have risen post-COVID. Urine drug screens have poor utility in the ED but are routinely obtained for medical clearance and in the management of patients with substance use disorder. Our primary goal was to measure the sensitivity of the opiate urine drug assay over time in opioid-related presentations to the ED. METHODS: We reviewed ED presentations at all EDs within our health system that were directly related to opioids from 1/1/2014 to 12/31/2022. For each patient included over the time frame, we identified whether a urine drug screen was obtained and the results from this screen. The urine drug screen available at all sites was an enzyme-multiplied immunoassay with an opiate screen (morphine antibody), but no fentanyl screen. The percent positivity for each drug category on enzyme multiplied immunoassay technique testing was calculated. Chi-squared tests were used to compare positivity rates between years. RESULTS: Opiate positivity declined over the last 9 years. Positivity rates from 2020 to 2022 were 5% ± 2% vs 82% ± 6% from 2014 to 2019 ( P < 0.001) Performance of UDS also declined over time (76% from 2014 to 2019 vs 46% from 2020 to 2022; P < 0.001). UDS was more likely to be performed in patients after a suicide attempt or when presenting after illicit use (66% vs 38%; P = 0.004). CONCLUSION: Opiate screen positivity decreased the last 9 years and may reflect wider use of fentanyl among this population starting in 2020.


Asunto(s)
Servicio de Urgencia en Hospital , Trastornos Relacionados con Opioides , Detección de Abuso de Sustancias , Humanos , Adolescente , Detección de Abuso de Sustancias/métodos , Masculino , Femenino , Trastornos Relacionados con Opioides/orina , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/diagnóstico , Analgésicos Opioides/orina , Analgésicos Opioides/uso terapéutico , Estudios Retrospectivos , COVID-19/orina , Sensibilidad y Especificidad , Sobredosis de Droga/orina , Sobredosis de Droga/epidemiología , Sobredosis de Droga/diagnóstico
4.
BMC Cardiovasc Disord ; 24(1): 339, 2024 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-38965461

RESUMEN

BACKGROUND: Zolpidem is a non-benzodiazepine hypnotic widely used to manage insomnia. Zolpidem-triggered atrial fibrillation (AF) in patients with cardiomyopathy has never been reported before. CASE PRESENTATION: A 40-year-old man with Duchenne muscular dystrophy-related cardiomyopathy attempted suicide and developed new-onset AF after zolpidem overdose. One year before admission, the patient visited our clinic due to chest discomfort and fatigue after daily walks for 1 month; both electrocardiography (ECG) and 24-hour Holter ECG results did not detect AF. After administration of cardiac medication (digoxin 0.125 mg/day, spironolactone 40 mg/day, furosemide 20 mg/day, bisoprolol 5 mg/day, sacubitril/valsartan 12/13 mg/day), he felt better. AF had never been observed before this admission via continuous monitoring during follow-up. Sixteen days before admission, the patient saw a sleep specialist and started zolpidem tartrate tablets (10 mg/day) due to insomnia for 6 months; ECG results revealed no significant change. The night before admission, the patient attempted suicide by overdosing on 40 mg of zolpidem after an argument, which resulted in severe lethargy. Upon admission, his ECG revealed new-onset AF, necessitating immediate cessation of zolpidem. Nine hours into admission, AF spontaneously terminated into normal sinus rhythm. Results from the ECG on the following days and the 24-hour Holter ECG at 1-month follow-up showed that AF was not detected. CONCLUSIONS: This study provides valuable clinical evidence indicating that zolpidem overdose may induce AF in patients with cardiomyopathy. It serves as a critical warning for clinicians when prescribing zolpidem, particularly for patients with existing heart conditions. Further large-scale studies are needed to validate this finding and to explore the mechanisms between zolpidem and AF.


Asunto(s)
Fibrilación Atrial , Cardiomiopatías , Zolpidem , Humanos , Zolpidem/efectos adversos , Masculino , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/inducido químicamente , Adulto , Cardiomiopatías/inducido químicamente , Cardiomiopatías/fisiopatología , Cardiomiopatías/diagnóstico , Intento de Suicidio , Sobredosis de Droga/diagnóstico , Frecuencia Cardíaca/efectos de los fármacos , Piridinas/efectos adversos
5.
Arch Toxicol ; 98(10): 3231-3240, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-38918214

RESUMEN

The toxicologist ascertains drug assumptions in case of paediatric intoxications and death for overdose. The analytical approach consists of initially screening and consequently confirming drug positivity. We developed a toxicological screening method and validated its use comparing the results with a LC-MS/MS analysis. The method identifies 751 drugs and metabolites (704 in positive and 47 in negative mode). Chromatographic separation was achieved eluting mobile phase A (10 mM ammonium formate) and B (0.05% formic acid in methanol) in gradient on Kinetex Phenyl-Hexyl (50 × 4.6 mm, 2.6 µm) with 0.7 mL/min flow rate for 11 min. Multiple Reaction Monitoring (MRM) was adopted as survey scan and, after an Information-Dependent Analysis (IDA) (threshold of 30,000 for positive and 1000 cps for negative mode), the Enhanced Product Ion (scan range: 50-700 amu) was triggered. The MS/MS spectrum generated was compared with one of the libraries for identification. Data processing was optimised through creation of rules. Sample preparation, mainly consisting of deproteinization and enzymatic hydrolysis, was set up for different matrices (blood, urine, vitreous humor, synovial fluid, cadaveric tissues and larvae). Cut-off for most analytes resulted in the lowest concentration tested. When the results from the screening and LC-MS/MS analysis were compared, an optimal percentage of agreement (100%) was assessed for all matrices. Method applicability was evaluated on real paediatric intoxications and forensic cases. In conclusion, we proposed a multi-targeted, fast, sensitive and specific MRM-IDA-EPI screening having an extensive use in different toxicological fields.


Asunto(s)
Toxicología Forense , Espectrometría de Masas en Tándem , Espectrometría de Masas en Tándem/métodos , Toxicología Forense/métodos , Humanos , Animales , Cromatografía Liquida/métodos , Pez Cebra , Preparaciones Farmacéuticas/análisis , Preparaciones Farmacéuticas/química , Reproducibilidad de los Resultados , Sobredosis de Droga/diagnóstico
6.
Int J Clin Pharmacol Ther ; 62(7): 334-338, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38726562

RESUMEN

The direct-acting oral anticoagulant dabigatran etexilate (DE) targets thrombin and is used widely to prevent thromboembolism. A 79-year-old man was admitted to the Emergency Department due to anuria for 2 days. An urgent laboratory examination revealed a serum creatinine concentration of 888 µmol/L. He was diagnosed with acute exacerbation of chronic renal insufficiency. During continuous renal replacement therapy (CRRT), the coagulation test showed a severe reduction in the fibrinogen level as well as a significantly prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT). The patient had been taking DE (110 mg twice daily) for a long time and had not suspended the medication or reduced the dose during the worsening of anuria. Therefore, it should be evaluated before considering plasma replacement therapy for the patient, whether the abnormal coagulation parameters were induced by interference of excessive DE. Tentatively, we used activated charcoal to treat the plasma and then retested the fibrinogen, PT, and APTT. Results showed that the coagulation indices nearly returned to normal. The present case indicated that activated charcoal could adsorb DE in plasma effectively and eliminate its interference with coagulation test results, thereby providing support for clinical diagnosis and treatment.


Asunto(s)
Carbón Orgánico , Dabigatrán , Sobredosis de Droga , Humanos , Masculino , Anciano , Carbón Orgánico/uso terapéutico , Sobredosis de Droga/diagnóstico , Coagulación Sanguínea/efectos de los fármacos , Antitrombinas , Pruebas de Coagulación Sanguínea , Tiempo de Protrombina , Anuria/inducido químicamente , Tiempo de Tromboplastina Parcial , Insuficiencia Renal Crónica/terapia
7.
Clin Toxicol (Phila) ; 62(5): 296-302, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38780445

RESUMEN

INTRODUCTION: Bupropion is a popular antidepressant due to its favorable side effect profile and indications for smoking cessation and weight loss. Due to the possibility of delayed onset seizure and other adverse outcomes after bupropion overdose, patients are often observed for periods of 12-24 hours following suspected ingestion. Tachycardia is a clinical predictor that holds promise in differentiating cases at risk for seizures from low-risk cases that do not require prolonged observation. This study assessed whether heart rate within the first eight hours of presentation can identify cases that do not require extended observation. METHODS: This is a retrospective cohort study of all supra-therapeutic bupropion cases from two hospital systems between 2010 and 2022. RESULTS: Data from 216 charts were included. Seizures, hypotension, and dysrhythmias occurred in 19 percent (n = 41), 1.4 percent (n = 3), 0.9 percent (n = 2) respectively. One patient died. Delayed adverse effects were rare (n = 4); they occurred from 14 hours to 28 hours post-ingestion. Maximum heart rate in eight hours was associated with a risk of adverse outcomes. (odds ratio, 1.07; 95 percent confidence interval: 1.05 to 1.09; P < 0.001). An eight hour maximum heart rate threshold of 104 beats/minute had a negative predictive value of 100 percent (95 percent confidence interval: 96.7 percent to 100 percent) for the occurrence of delayed adverse effects. All patients with delayed effects had tachycardia within five hours of emergency department arrival. DISCUSSION: Delayed adverse outcomes of seizures, hypotension, dysrhythmia, and death were uncommon in this cohort. Heart rate during the first eight hours of observation performs reliably as a screening test to identify patients at low risk for delayed adverse outcomes. This study is limited by its retrospective nature, the inability to ascertain time of ingestion for most cases and the lack of confirmatory laboratory testing. CONCLUSION: This study supports the use of an eight hour observation period when there are no other clinical signs of toxicity to warrant admission and if no co-ingestion or administration of substances that mask tachycardia are present.


Asunto(s)
Bupropión , Sobredosis de Droga , Frecuencia Cardíaca , Valor Predictivo de las Pruebas , Convulsiones , Humanos , Bupropión/envenenamiento , Estudios Retrospectivos , Sobredosis de Droga/diagnóstico , Frecuencia Cardíaca/efectos de los fármacos , Femenino , Masculino , Adulto , Convulsiones/inducido químicamente , Convulsiones/fisiopatología , Persona de Mediana Edad , Adulto Joven , Taquicardia/inducido químicamente , Taquicardia/fisiopatología , Antidepresivos de Segunda Generación/envenenamiento , Adolescente
8.
J Forensic Sci ; 69(4): 1350-1363, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38647080

RESUMEN

With the escalating overdose epidemic, many surveillance efforts have appeared. In 2018, King County Medical Examiner's Office (KCMEO) initiated a fatal overdose surveillance project aimed at expediting death certification and disseminating timely information. In this project, KCMEO investigators collected items of evidence of drug use from overdose death scenes, which were tested by five in-house methods, four using handheld devices: TruNarc Raman spectrometer, with and without the manufacture's H-Kit, Rigaku ResQ Raman spectrometer, and MX908 mass spectrometer. The fifth in-house method used fentanyl-specific urine test strips. Results from in-house testing were compared with results from Washington State Patrol (WSP) Materials Analysis Laboratory. From 2019 to 2022, there were 4244 evidence items of drugs and paraphernalia collected from 1777 deaths scenes. A total of 7526 in-house tests were performed on collected specimens, and 2153 tests were performed by the WSP laboratory using standard analytical methods. The WSP results served as reference standards to calculate performance metrics of the in-house methods. Sensitivities, specificities, and predictive values ranged from good to poor depending on the method, drug, and evidence type. Certain drugs were often associated with specific evidence types. Acetaminophen was frequently found in combination with fentanyl. Fentanyl test strips gave good scores for detecting fentanyl; otherwise, in-house methods using handheld devices had poor performance scores with novel drugs and drugs diluted in mixtures. The results showed that in-house testing of drug evidence has value for medical examiner overdose surveillance, but it is resource intensive, and success depends on collaboration with forensic laboratories.


Asunto(s)
Médicos Forenses , Sobredosis de Droga , Toxicología Forense , Sensibilidad y Especificidad , Detección de Abuso de Sustancias , Humanos , Sobredosis de Droga/diagnóstico , Detección de Abuso de Sustancias/métodos , Toxicología Forense/métodos , Fentanilo/análogos & derivados , Fentanilo/envenenamiento , Fentanilo/análisis , Fentanilo/orina , Washingtón/epidemiología , Espectrometría de Masas
9.
J Appl Lab Med ; 9(3): 629-634, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38300830

RESUMEN

Historically, xylazine has been utilized in veterinary medicine for decades as an anesthetic and analgesic sedative to facilitate safe handling, diagnostic testing, and surgical procedures in large animals. Currently, xylazine is an emerging threat to human health. It has been detected in the illicit drug supply chain, often as an adulterant. It has been more commonly added to illicit substances, most notably fentanyl, by drugmakers to enhance drug effect. End users are often unaware of its presence. This is alarming given the large number of xylazine-involved overdose deaths while laboratory detections are deficient and reversal agents are absent. Herein, we present the first documented case of xylazine identified via gas chromatography-tandem mass spectrometry at University of California Davis Health despite a peculiarly mild clinical presentation. We hope to increase awareness of this potentially fatal adulterant that is often missed in evaluation and engender further opportunities to study this ongoing issue.


Asunto(s)
Fentanilo , Xilazina , Humanos , Masculino , Analgésicos Opioides/análisis , Contaminación de Medicamentos , Sobredosis de Droga/diagnóstico , Fentanilo/análogos & derivados , Fentanilo/análisis , Fentanilo/administración & dosificación , Cromatografía de Gases y Espectrometría de Masas , Espectrometría de Masas en Tándem/métodos , Xilazina/efectos adversos , Adulto
10.
Am Fam Physician ; 109(2): 143-153, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38393798

RESUMEN

Poisoning is the leading cause of injury-related morbidity and mortality in the United States. The highest rates of exposure to poisons occur in children five years and younger, but opioid overdoses in young adults account for most deaths from poisonings in recent years. Intentional or accidental medication poisoning should be considered when evaluating patients with mental status changes, vital sign abnormalities, seizures, and gastrointestinal or cardiovascular problems. For all poisoned patients, a comprehensive history and physical examination are needed. Knowledge of toxidromes may help identify the cause in unknown ingestions; however, their usefulness may be limited when multiple toxins are ingested. Electrocardiography is indicated in patients reporting chest pain and dyspnea and in overdoses of beta blockers, tricyclic antidepressants, and antidysrhythmics. Measurement of electrolyte, serum creatinine, and serum bicarbonate levels and calculation of the anion gap may be helpful based on the clinical presentation. Treatment of a patient with acute poisoning is based on resuscitation and stabilization with a focus on airway, breathing, and circulation. When poisoning is suspected, the Poison Control provides health care workers and the public with access to a specialist 24 hours a day.


Asunto(s)
Sobredosis de Droga , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Intoxicación , Niño , Adulto Joven , Humanos , Estados Unidos/epidemiología , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/terapia , Intoxicación/diagnóstico , Intoxicación/terapia
11.
Clin Toxicol (Phila) ; 62(1): 32-38, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38329803

RESUMEN

OBJECTIVE: The QRS complex duration is commonly used to prognosticate severity, predict outcomes, and indicate treatment in overdose. However, literature to support this practice is mixed in tricyclic antidepressant overdoses and absent in non-tricyclic antidepressant overdoses. Our objective was to assess the validity of QRS complex duration as a prognostic marker in overdose. METHODS: This was a secondary analysis of cases reported to the Toxicology Investigators Consortium between January 1, 2010, and December 31, 2022. Cases were assessed to determine the six xenobiotics most associated with QRS complex prolongation. All cases involving these six xenobiotics, regardless of QRS complex duration, constituted the study cohort. Inclusion criteria were cases of patients older than 12 years old with single-xenobiotic exposures. Clinical outcomes evaluated were seizure, ventricular dysrhythmia, metabolic acidosis, and death. RESULTS: Of 94,939 total cases, diphenhydramine, amitriptyline, bupropion, quetiapine, nortriptyline, and cocaine were most associated with QRS complex prolongation. Inclusion criteria were met by 4,655 cases of exposure to these xenobiotics. QRS complex prolongation was associated with increased odds ratio of seizure in all included xenobiotics, of ventricular dysrhythmia in all included xenobiotics except nortriptyline, and of metabolic acidosis or death in all included xenobiotics except nortriptyline and quetiapine. A normal QRS complex duration had a negative predictive value of greater than or equal to 93.0 percent of developing metabolic acidosis and 98.0 percent of developing a ventricular dysrhythmia or death from the xenobiotics studied. DISCUSSION: This study demonstrates that patients with QRS complex prolongation from all six xenobiotics studied had an increased prevalence and odds of developing severe outcomes. Furthermore, patients who did not develop QRS complex prolongation were unlikely to develop a ventricular dysrhythmia, metabolic acidosis, or death. These findings were noted in six xenobiotics that mechanistically can cause QRS complex prolongation through sodium channel or gap junction inhibition. CONCLUSION: Identification of patients at risk for severe outcomes after overdose can be aided by measuring the QRS complex duration. If prospectively validated, these outcomes have implications on risk stratification, disposition level of care, and appropriateness of treatments.


Asunto(s)
Acidosis , Sobredosis de Droga , Humanos , Niño , Nortriptilina , Fumarato de Quetiapina , Xenobióticos/toxicidad , Electrocardiografía , Arritmias Cardíacas , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/terapia , Convulsiones/inducido químicamente
12.
BMC Emerg Med ; 24(1): 5, 2024 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-38185623

RESUMEN

BACKGROUND: During disasters (including epidemics such as coronavirus disease 2019), the capacity of emergency departments is exceeded, thereby hindering the administration of appropriate lifesaving measures. Furthermore, the number of overdose patients increases because of the stress overload during emergency situation. The fact that overdose patients are forced to be transported to medical facilities that do not typically treat them is becoming worrisome. Moreover, there is no definitive score for overdose. This study aimed to create a patient-specific scoring system to assess overdose. METHODS: This was a retrospective single-center study. The evidence-based OD score was evaluated on a scale of 0-15. Further, logistic analysis and receiver operating characteristic (ROC) curve analysis were performed to evaluate the score. RESULTS: Overall, 262 patients (including 118 overdose patients) receiving care at the intensive care unit of Japan's Teikyo University Hospital in 2021 were targeted. Regarding the total OD score, ROC analysis revealed a cutoff of 8 (area under the curve [AUC]: 0.99, 95% confidence interval [CI]: 0.980-0.997, sensitivity: 0.95, specificity: 0.95, p < 0.05), which was considered to indicate an overdose. Of the items evaluated in the OD score, the scenario at the location of the patient's discovery (adjusted odds ratio [AOR]: 16.8, 95% CI: 5.0-255.9, p = 0.002) and recent experience of mental anxiety (AOR: 55.7, 95% CI: 2.8-5399.5, p = 0.03) significantly predicted an overdose in multivariable logistic regression analysis. External validation revealed that the OD score could also identify overdose in patients treated in a cohort from 2022 (average cutoff: 8.6, average AUC: 1.0, p < 0.0001). CONCLUSIONS: The OD score could accurately assess overdose patients. Medical facilities that do not frequently address overdose patients will benefit from the use of this score.


Asunto(s)
COVID-19 , Sobredosis de Droga , Humanos , Estudios Retrospectivos , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/epidemiología , Ansiedad , Área Bajo la Curva , COVID-19/epidemiología
13.
Med Clin (Barc) ; 162(7): 328-332, 2024 04 12.
Artículo en Inglés, Español | MEDLINE | ID: mdl-38182480

RESUMEN

INTRODUCTION: Recent publications relate the presence of hypoglycemia in venlafaxine (VLX) poisoning depending on the dose. Our aim was to analyze the clinical characteristics of patients who presented hypoglycemia induced by VLF overdose. PATIENTS AND METHODS: Retrospective study carried out in the Balearic Islands (2020-2023). INCLUSION CRITERIA: serum concentrations of VLX + O-desmethyl-venlafaxine (O-VLX)>800 ng/mL. The characteristics of patients with and without hypoglycemia were compared. RESULTS: Twenty-one patients were included, 8 (38.1%) with hypoglycemia. No differences were found in the doses referred to in both groups. Peak concentrations of VLX + O-VLX (ng/mL) were 9,783 [4,459-17,976] in patients with hypoglycemia and 1,413 [930-1,719] in patients without hypoglycemia (p<0.0001). The presence of hypoglycemia was associated with: lower age and level of consciousness; and higher frequency of suicide attempts, seizures, mydriasis, tachycardia and serotonin syndrome, invasive respiratory support, fluid therapy and ICU admission (p<0.05). CONCLUSIONS: The detection of hypoglycemia in a VLX overdose case is a readily available marker to suspect the severity of the patient. In any case, serum concentrations when available allow us to confirm intoxication.


Asunto(s)
Sobredosis de Droga , Hipoglucemia , Humanos , Clorhidrato de Venlafaxina/farmacología , Clorhidrato de Venlafaxina/uso terapéutico , Estudios Retrospectivos , Antidepresivos/uso terapéutico , Sobredosis de Droga/diagnóstico , Hipoglucemia/inducido químicamente , Hipoglucemia/diagnóstico
14.
PLoS One ; 19(1): e0292170, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38289927

RESUMEN

The goal of this study is to develop and validate a lightweight, interpretable machine learning (ML) classifier to identify opioid overdoses in emergency medical services (EMS) records. We conducted a comparative assessment of three feature engineering approaches designed for use with unstructured narrative data. Opioid overdose annotations were provided by two harm reduction paramedics and two supporting annotators trained to reliably match expert annotations. Candidate feature engineering techniques included term frequency-inverse document frequency (TF-IDF), a highly performant approach to concept vectorization, and a custom approach based on the count of empirically-identified keywords. Each feature set was trained using four model architectures: generalized linear model (GLM), Naïve Bayes, neural network, and Extreme Gradient Boost (XGBoost). Ensembles of trained models were also evaluated. The custom feature models were also assessed for variable importance to aid interpretation. Models trained using TF-IDF feature engineering ranged from AUROC = 0.59 (95% CI: 0.53-0.66) for the Naïve Bayes to AUROC = 0.76 (95% CI: 0.71-0.81) for the neural network. Models trained using concept vectorization features ranged from AUROC = 0.83 (95% 0.78-0.88)for the Naïve Bayes to AUROC = 0.89 (95% CI: 0.85-0.94) for the ensemble. Models trained using custom features were the most performant, with benchmarks ranging from AUROC = 0.92 (95% CI: 0.88-0.95) with the GLM to 0.93 (95% CI: 0.90-0.96) for the ensemble. The custom features model achieved positive predictive values (PPV) ranging for 80 to 100%, which represent substantial improvements over previously published EMS encounter opioid overdose classifiers. The application of this approach to county EMS data can productively inform local and targeted harm reduction initiatives.


Asunto(s)
Sobredosis de Droga , Servicios Médicos de Urgencia , Sobredosis de Opiáceos , Humanos , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/epidemiología , Sobredosis de Droga/tratamiento farmacológico , Teorema de Bayes , Servicios Médicos de Urgencia/métodos , Aprendizaje Automático , Analgésicos Opioides/uso terapéutico
15.
Drug Alcohol Rev ; 43(1): 213-225, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37596977

RESUMEN

INTRODUCTION: Drug-related deaths involving an opioid are at all-time highs across the United Kingdom. Current overdose antidotes (naloxone) require events to be witnessed and recognised for reversal. Wearable technologies have potential for remote overdose detection or response but their acceptability among people who use opioids (PWUO) is not well understood. This study explored facilitators and barriers to wearable technology acceptability to PWUO. METHODS: Twenty-four participants (79% male, average age 46 years) with current (n = 15) and past (n = 9) illicit heroin use and 54% (n = 13) who were engaged in opioid substitution therapy participated in semi-structured interviews (n = 7) and three focus groups (n = 17) in London and Nottingham from March to June 2022. Participants evaluated real devices, discussing characteristics, engagement factors, target populations, implementation strategies and preferences. Conversations were recorded, transcribed and thematically analysed. RESULTS: Three themes emerged: device-, person- and environment-specific factors impacting acceptability. Facilitators included inconspicuousness under the device theme and targeting subpopulations of PWUO at the individual theme. Barriers included affordability of devices and limited technology access within the environment theme. Trust in device accuracy for high and overdose differentiation was a crucial facilitator, while trust between technology and PWUO was a significant environmental barrier. DISCUSSION AND CONCLUSIONS: Determinants of acceptability can be categorised into device, person and environmental factors. PWUO, on the whole, require devices that are inconspicuous, comfortable, accessible, easy to use, controlled by trustworthy organisations and highly accurate. Device developers must consider how the type of end-user and their environment moderate acceptability of the device.


Asunto(s)
Sobredosis de Droga , Sobredosis de Opiáceos , Dispositivos Electrónicos Vestibles , Humanos , Masculino , Persona de Mediana Edad , Femenino , Analgésicos Opioides/uso terapéutico , Sobredosis de Opiáceos/tratamiento farmacológico , Naloxona/uso terapéutico , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/tratamiento farmacológico , Antagonistas de Narcóticos/uso terapéutico
16.
J Med Toxicol ; 20(1): 13-21, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38048033

RESUMEN

INTRODUCTION: The USA continues to face a fentanyl-driven overdose epidemic. Prior research has demonstrated users of illicit opioids are concerned about fentanyl exposure and overdose, but the strategies they report using to detect fentanyl's presence lack empirical support. This study compares self-report and biologically detected fentanyl use and investigates overdose risk and risk reduction behaviors among a sample of high-risk people who use opioids. METHODS: Structured enrollment interviews conducted as part of a larger clinical trial assessed self-reported fentanyl exposure as well as strategies used to determine believed fentanyl exposure and prevent overdose among 240 participants enrolled at a Chicago, IL syringe service program. Urinalysis measured actual fentanyl exposure. RESULTS: Most participants identified as African American (66.7%) and had considerable overdose experience (76.7% lifetime and 48% in the past year). Most also tested positive for fentanyl (93.75%) despite reporting no past year use of fentanyl or fentanyl-adulterated drugs (64.17%). The most utilized approaches reported for identifying fentanyl exposure were stronger effects of the drug (60.7%), sight or taste (46.9%), and being told by someone using the same drugs (34.2%). Few participants (14%) reported using fentanyl test strips. No significant associations were identified between self-report and urinalysis measures or urinalysis results and risk reduction strategies. CONCLUSION: This study adds to prior fentanyl exposure risk research. The disconnect between participants' fentanyl detection methods and reported overdose experiences supports the need for more research to identify and understand factors driving access and use of overdose prevention resources and strategies.


Asunto(s)
Sobredosis de Droga , Trastornos Relacionados con Opioides , Humanos , Fentanilo , Analgésicos Opioides/uso terapéutico , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/epidemiología , Sobredosis de Droga/terapia , Urinálisis , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/tratamiento farmacológico
18.
Clin Toxicol (Phila) ; 61(12): 1040-1046, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38088581

RESUMEN

INTRODUCTION: The United States drug overdose crisis continues to evolve. Xylazine has been increasingly identified as an adulterant in illicit opioid supplies. The incorporation of novel adulterants, like xylazine, into the illicit drug supply adds complexity to post-mortem toxicology testing, public health messaging, substance use mitigation, and the treatment of people who use drugs. METHODS: We assessed trends, decedent characteristics, drug co-detection, and blood concentrations of xylazine-positive post-mortem cases in Michigan. We utilized a toxicology testing program capable of detecting several opioids and non-opioids in post-mortem blood samples within 72 hours. RESULTS: A total of 279 deaths were xylazine-positive between October 2019 and June 2023, with 100 percent positive for fentanyl. Only 30 percent of xylazine-involved samples were positive for naloxone, while 21.2 percent of xylazine-negative and opioid-positive samples were positive for naloxone. The percentage of xylazine-positive deaths increased from 3.2 percent in 2021 to 4.7 percent in January-June 2023. A median of five total drug groups were present among xylazine-positive deaths. Post-mortem xylazine concentrations for 55 decedent blood samples ranged from 5.2 to 200 µg/L. DISCUSSION: Our study demonstrated increases in xylazine detection among post-mortem cases. Our findings are consistent with national trends of increasing xylazine presence among drug-involved deaths. Our range of detected post-mortem xylazine blood concentrations was consistent with what has been reported in previous literature. Fentanyl was detected in 100 percent of xylazine-positive overdose deaths. Naloxone detection was relatively low, highlighting the continued importance of increasing naloxone access and distribution. Deaths associated with xylazine often involved multiple other drugs. Limited human clinical xylazine research precludes accurate interpretation and attribution of causality from these data. CONCLUSIONS: Overdose-related deaths with xylazine detection are increasing in Michigan and across the United States. Further clinical and toxicological research can help contextualize the clinical significance of xylazine in opioid overdose, clarify epidemiologic and clinical research, and inform appropriate public health messaging.


Asunto(s)
Sobredosis de Droga , Trastornos Relacionados con Sustancias , Humanos , Estados Unidos/epidemiología , Analgésicos Opioides , Xilazina , Sobredosis de Droga/diagnóstico , Fentanilo , Naloxona
19.
J Int Med Res ; 51(10): 3000605231205449, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37843498

RESUMEN

Drug overdose can lead to a range of symptoms, including potentially life-threatening cardiac arrhythmias. However, identifying the specific causative drug upon admission can be challenging in many cases. The toxidrome approach is a method that utilizes toxidromes, which are collections of findings obtained from physical examination and ancillary tests, that may be caused by a specific toxin. In this particular case, a man presented with an unknown drug overdose that caused symptoms indicative of anticholinergic effects and abnormal electrocardiogram (ECG) findings. The ECG revealed an R wave in lead aVR, S waves in leads I and aVL, and wide QRS tachycardia with a Brugada pattern. Shortly after arrival, the patient developed cardiac arrest due to a lethal arrhythmia. Prompt initiation of venoarterial extracorporeal cardiopulmonary membrane oxygenation (VA-ECMO) was performed. Fortunately, the patient achieved full neurological recovery, and the overdosed drug was identified as diphenhydramine. When diagnosing and treating drug overdose caused by an unidentified substance, diphenhydramine toxicity should be considered when an anticholinergic toxidrome is present and a Brugada pattern is observed on the ECG. VA-ECMO demonstrates potential as a viable treatment option when initial interventions prove ineffective.


Asunto(s)
Sobredosis de Droga , Oxigenación por Membrana Extracorpórea , Masculino , Humanos , Oxigenación por Membrana Extracorpórea/métodos , Difenhidramina , Arritmias Cardíacas , Electrocardiografía , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/terapia , Antagonistas Colinérgicos
20.
J Anal Toxicol ; 47(9): 867-870, 2023 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-37756625

RESUMEN

Thiocyanate is an inorganic compound used in industrial applications. Here, we report a case of suicidal death due to acute thiocyanate overdose. A 44-year-old man who consumed an unknown amount of thiocyanate solution was transferred to the emergency room and died 2 h after admission. An autopsy was performed 2 days after death. General toxicological analysis of blood using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry found no drug or alcohol. Quantification using GC-MS post-derivatization with pentafluorobenzyl bromide revealed 2,290 and 1,920 mg/L of thiocyanate in the heart and femoral blood samples, respectively. Thus, the cause of death was attributed to thiocyanate overdose. This study provides useful information for the interpretation of thiocyanate-related fatalities.


Asunto(s)
Sobredosis de Droga , Tiocianatos , Masculino , Humanos , Adulto , Cromatografía de Gases y Espectrometría de Masas , Sobredosis de Droga/diagnóstico , Autopsia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA