Anticoagulants in poisoning
Blood coagulation is the result of a complex cascade of proteases that produce an insoluble fibrin polymer from soluble fibrinogen. Abnormal or excessive coagulation can cause venous thromboembolic disorders or arterial thromboembolic disease. Parenteral and oral anticoagulants have demonstrated efficacy in treating these conditions. Haemorrhage is a predicable consequence of anticoagulant poisoning. Treatment involves the general management of haemorrhage, and the administration of specific antidotes for individual anticoagulants is discussed. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: James Coulson Tags: Poisonous substances Source Type: research
Poisoning by pesticides
Around 150,000 people die each year from pesticide poisoning. Most deaths result from self-poisoning by ingestion, rather than occupational or accidental exposures, which are typically topical or inhalational. Severe pesticide poisoning is more common in rural lower- and middle-income countries where pesticides are widely used in smallholder agricultural practice and therefore freely available. Significant acute poisoning is much less common in industrialized countries; here the long-term effects of low-dose chronic exposure most concern the population. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Michael Eddleston Tags: Poisonous substances Source Type: research
Poisoning with cardioactive substances
Cardiovascular poisoning may be significant from toxicity related to β-blockers, calcium channel blockers and digoxin. Various treatment options exist that are based on the pharmacological pattern of toxicity from these drugs. These include supportive clinical care and the use of specific antidotes. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: John Archer, Paul I. Dargan Tags: Poisonous substances Source Type: research
Poisoning by opioids
Opioids are among the most commonly prescribed analgesic medications, and opioid toxicity is becoming an increasing problem across the world. Patients typically present with a triad of signs: reduced consciousness, miosis and a reduced respiratory rate with shallow breaths. Patients with significant opioid toxicity are at risk of airway compromise, and basic supportive measures should be performed. Naloxone is a non-selective μ-opioid receptor antagonist that competitively binds to the μ-opioid receptor and should be administered, ideally intravenously, to patients with significant opioid toxicity. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Kerry A Layne, David M Wood Tags: Poisonous substances Source Type: research
Principles of assessment and diagnosis of the poisoned patient
Assessment of patients with acute poisoning includes history-taking, assessment of airway, breathing, circulation and consciousness level, physical examination to elicit relevant clinical signs and appropriate investigations. Diagnosis is usually based on the history, recognition of toxidromes (when present) and results of investigations. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Aidan King, Ruben Thanacoody Tags: General aspects of poisoning Source Type: research
Poisoning by antidepressants and antipsychotics
Tricyclic antidepressants, citalopram, venlafaxine and monoamine oxidase inhibitors are the most toxic antidepressants in overdose. Features include hypotension and arrhythmias that are best managed by the aggressive correction of metabolic acidosis with sodium bicarbonate. Antipsychotic drugs differ in their chemical structure and specificity at dopamine receptors. Overdose produces a range of adverse effects including sedation and acute extrapyramidal reactions. Cardiovascular effects including hypotension, prolongation of the QT interval and, potentially, arrhythmias including torsade de pointes are also seen. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Aidan King, Ruben Thanacoody Tags: Poisonous substances Source Type: research
Poisoning by venomous animals
Poisoning by venomous creatures is common. Most is benign, causing only minor irritation or pain, but rarely significant morbidity and mortality can occur. Medically important venomous creatures include snakes, spiders, scorpions and marine creatures. For suspected cases of severe envenoming, seek early expert advice from a clinical toxicologist or poisons information centre. First aid measures include pressure bandaging of the affected limb with immobilization in suspected snakebite and funnel web spider bite, and hot water immersion therapy for many marin e stings. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Katherine Z. Isoardi, Geoffrey K. Isbister Tags: Poisonous substances Source Type: research
Poisoning by carbon monoxide
Accidental carbon monoxide (CO) poisoning causes 100 hospital admissions and 7 deaths per million UK population. Toxicity occurs mainly through the formation of carboxyhaemoglobin (COHb), causing ischaemia of vital organs. Features are non-specific and include headache, gastrointestinal upset, dizziness, weakness, convulsions, coma, chest pain and dyspnoea. Neuropsychiatric features can appear up to 40 days after the initial exposure. The diagnosis can be missed unless a history of exposure to sources of CO is elicited or a CO alarm triggered. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Aravindan Veiraiah Tags: Poisonous substances Source Type: research
Poisoning by metals
Lead can be absorbed after inhalation or ingestion and is toxic to most organ systems. Management involves avoidance of exposure and, in more severe cases, chelation therapy with either sodium calcium edetate or dimercaptosuccinic acid. Iron poisoning causes metabolic effects in proportion to the concentrations of free iron, although individual responses vary. Toxicity is therefore related to the dose ingested. Iron concentrations can rise and fall, making plasma concentrations difficult to interpret in acute poisoning. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Muhammad EMO Elamin, Sally M Bradberry, James W Dear Tags: Poisonous substances Source Type: research
Drug misuse
While the misuse of traditional drugs remains common, the emergence of new psychoactive substances (NPS) has changed the landscape of drug misuse in recent years. Although hundreds of NPS have been identified, opioids, including new synthetic examples, still dominate mortality. The exact substances causing toxicity are often unknown on presentation, and multiple exposures are commonly involved. Management is therefore based on a recognition of the drug group(s) involved by identifying the clinical toxidrome. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Fraser JH. Henderson, Simon L. Hill, Simon HL. Thomas Tags: General aspects of poisoning Source Type: research
Epidemiology of poisoning
Accidental poisoning is most common in children, but deliberate self-harm becomes predominant in teenagers and early adulthood. The epidemiology of poisoning can be studied using mortality data, hospital admission rates and enquiries to poisons information services. Effective strategies for preventing suicide and reducing the risk of accidental poisoning require an understanding of the epidemiology of poisoning. (Source: Medicine)
Source: Medicine - April 29, 2024 Category: Internal Medicine Authors: Ruben Thanacoody, Mark Anderson Tags: General aspects of poisoning Source Type: research
Vitamin D opposes multilineage cell differentiation induced by Notch inhibition and BMP4 pathway activation in human colon organoids
Cell Death & Disease, Published online: 29 April 2024; doi:10.1038/s41419-024-06680-zVitamin D opposes multilineage cell differentiation induced by Notch inhibition and BMP4 pathway activation in human colon organoids (Source: Cell death and disease)
Source: Cell death and disease - April 29, 2024 Category: Internal Medicine Authors: Pilar Bustamante-Madrid Antonio Barb áchano David Albandea-Rodr íguez Javier Rodr íguez-Cobos Nuria Rodr íguez-Salas Isabel Prieto Aurora Burgos Jaime Mart ínez de Villarreal Francisco X. Real Jos é Manuel González-Sancho Mar ía Jesús Larriba Mig Source Type: research
Identification of a set of genes potentially responsible for resistance to ferroptosis in lung adenocarcinoma cancer stem cells
Cell Death & Disease, Published online: 29 April 2024; doi:10.1038/s41419-024-06667-wIdentification of a set of genes potentially responsible for resistance to ferroptosis in lung adenocarcinoma cancer stem cells (Source: Cell death and disease)
Source: Cell death and disease - April 29, 2024 Category: Internal Medicine Authors: Francesca Ascenzi Antonella Esposito Sara Bruschini Valentina Salvati Claudia De Vitis Valeria De Arcangelis Giulia Ricci Angiolina Catizione Simona di Martino Simonetta Buglioni Massimiliano Bassi Federico Venuta Francesca De Nicola Alice Massacci Isabel Source Type: research
Mature neurons from iPSCs unveil neurodegeneration-related pathways in mucopolysaccharidosis type II: GSK-3β inhibition for therapeutic potential
Cell Death & Disease, Published online: 29 April 2024; doi:10.1038/s41419-024-06692-9Mature neurons from iPSCs unveil neurodegeneration-related pathways in mucopolysaccharidosis type II: GSK-3β inhibition for therapeutic potential (Source: Cell death and disease)
Source: Cell death and disease - April 29, 2024 Category: Internal Medicine Authors: Tzu-Yu Chen Shuan-Pei Lin De-Fong Huang Hsien-Sung Huang Feng-Chiao Tsai Li-Jen Lee Hsiang-Yu Lin Hsiang-Po Huang Source Type: research
Cancer Screening Through Federally Qualified Health Centers
Although much progress has been made in delivering cancer screening in the US, particularly for breast, cervical, and colorectal cancer, implementation remains suboptimal, particularly for populations experiencing systemic marginalization and economic disadvantage. Efforts to improve cancer screening implementation and reduce inequities are critical for achieving the goals of a just, high-performing health care system in the US. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 29, 2024 Category: Internal Medicine Source Type: research
