A description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection.
We aimed to describe the ...epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain.
This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020.
The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0% versus 8.4%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1% versus 5.8%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike.
Screening systems for SARS-CoV-2 infection were scarce during the first wave, but were more adequate during the second wave, reflecting the usefulness of surveillance systems to detect a high number of asymptomatic infected individuals and their contacts, to help control this pandemic. The characteristics of individuals with SARS-CoV-2 infection in the first and second waves differed substantially; individuals in the first wave were older and had a worse health condition.
Elaborar un listado de medicamentos altamente tóxicos en la infancia (MAT), comercializados en España, diferenciando aquellos que alcanzan la dosis letal para un niño de 10kg con la ingesta de 1-3 ...unidades.
Se definió MAT como aquellos capaces de producir intoxicaciones graves o letales en niños menores de 8 años. Se consideró toxicidad grave la correspondiente al grado 3 en la clasificación Poisoning Severity Score y la categoría «major effects» en las publicaciones de la American Association of Poison Control Centers. Se realizó una revisión bibliográfica de los informes anuales de la American Association of Poison Control Centers y de PubMed entre enero 2000 y febrero 2019 (palabras clave: «severe», «fatal», «life-threatening», «poisoning», «child», «pediatric», «toxicological emergency»). Además, se realizó un estudio observacional retrospectivo de menores de 8 años que consultaron en un servicio de urgencias pediátrico por sospecha de intoxicación farmacológica entre julio 2012 y junio 2018.
Se seleccionaron los principios activos responsables comercializados en España y se determinó la dosis letal o la dosis altamente tóxica. Se calculó el número de unidades necesarias para alcanzarla en niños de 10kg
Se identificaron 7 grupos de MAT: analgésicos; psicofármacos y medicamentos neuromusculares; anticatarrales descongestivos-antitusígenos-antihistamínicos-antiasmáticos; medicamentos cardiovasculares; antimicrobianos; preparados tópicos y otros medicamentos. En 29 principios activos, la ingesta de una única unidad podría causar la muerte en un lactante de 10kg de peso, en 13 podría causarla la ingesta de 2 unidades y en 10 la ingesta de 3 unidades.
Existen numerosos MAT comercializados en España, algunos de ellos disponibles en presentaciones potencialmente letales con pocas unidades.
To prepare a list of highly toxic drugs in infants (HTDs) marketed in Spain, comparing those that reach the lethal dose in a child of 10kg with the ingestion of 1 to 3 units.
HTDs are defined as those capable of causing severe or lethal poisoning in children less than 8-year-old. Severe poisoning is considered as that corresponding to Grade 3 in the Poisoning Severity Score classification and to the “major effects” category in publications in the American Association of Poison Control Centers. A literature review was carried out on the annual reports of the American Association of Poison Control Centers, as well as in PubMed, between January 2000 and February 2019 (Keywords “severe”, “fatal”, “life-threatening”, “poisoning”, “child”, “paediatric”, “toxicological emergency”). An observational, retrospective study was also conducted on infants less than 8-year-old that were seen in a Paediatric Emergency Department due to suspected drug poisoning between July 2012 and June 2018.
The active ingredients responsible marketed in Spain were selected, and the lethal or highly toxic doses were determined. The number of units (pills) necessary to reach this dose in children of 10kg was calculated.
A total of 7 HTD groups were identified: analgesics; psychotropics and other medication used in neurological disorders; catarrh decongestants – cough –antihistamine – asthma drugs; cardiovascular drugs; antibiotics, topical preparations, and other drugs. In 29 active ingredients, the ingestion of a single pill could cause death in 10kg infant, in another 13, the ingestion of 2 pills could cause death, as well as the ingestion of 3 pills in 10 cases.
There are numerous HTDs marketed in Spain, some of which are available in potentially fatal presentations with few pills.
According to Harnet et al,1 in the United Kingdom, the Royal College of Emergency Medicine and the National Poisons Information Service have issued national guidance on the availability of antidotes ...in emergency departments.2 The guidance serves as a tool for improving timely availability of antidotes in hospitals to optimise how patients who have been poisoned are managed. ...of this study, recommendations on improving the availability of antidotes in hospitals were published, according to their level of complexity.7 In 2015, a virtual Antidote Network of hospital pharmacy departments was created to address the problem in Catalonia and to improve communication. ...it can improve the quality of care for patients who present at emergency departments for treatment of acute poisoning.
Objective: To prepare a list of highly toxic drugs in infants (HTDs) marketed in Spain, comparing those that reach the lethal dose in a child of 10 kg with the ingestion of one to three units. ...Method: HTDs are defined as those capable of causing severe or lethal poisoning in children less than 8-year-old. Severe poisoning is considered as that corresponding to Grade 3 in the Poisoning Severity Score classification and to the “major effects” category in publications in the American Association of Poison Control Centers (AAPCC). A literature review was carried out on the annual reports of the AAPCC, as well as in PubMed, between January 2000 and February 2019 (key words: “severe”, “fatal”, “life-threatening”, “poisoning”, “child”, “paediatric”, “toxicological emergency”). An observational, retrospective study was also conducted on infants less than 8-year-old that were seen in a Paediatric Emergency Department due to suspected drug poisoning between July 2012 and June 2018.The active ingredients responsible marketed in Spain were selected, and the lethal or highly toxic doses were determined. The number of units (pills) necessary to reach this dose in children of 10 kg was calculated. Results: A total of 7 HTD groups were identified: analgesics; psychotropics and other medication used in neurological disorders; catarrh decongestants – cough –antihistamine – asthma drugs; cardiovascular drugs; antibiotics, topical preparations, and other drugs. In 29 active ingredients, the ingestion of a single pill could cause death in 10 kg infant, in another 13, the ingestion of 2 pills could cause death, as well as the ingestion of 3 pills in 10 cases. Conclusion: There are numerous HTDs marketed in Spain, some of which are available in potentially fatal presentations with few pills. Resumen: Objetivo: Elaborar un listado de medicamentos altamente tóxicos en la infancia (MAT), comercializados en España, diferenciando aquellos que alcanzan la dosis letal para un niño de 10 kg con la ingesta de una a tres unidades. Método: Se definió MAT como aquellos capaces de producir intoxicaciones graves o letales en niños menores de 8 años. Se consideró toxicidad grave la correspondiente al grado 3 en la clasificación Poisoning Severity Score y a la categoría “major effects” en las publicaciones de la American Association of Poison Control Centers (AAPCC). Se realizó una revisión bibliográfica de los informes anuales de la AAPCC y de PubMed entre enero 2000 y febrero 2019 (palabras clave: “severe”, “fatal”, “life-threatening”, “poisoning”, “child”, “pediatric”, “toxicological emergency”). Además, se realizó un estudio observacional retrospectivo de menores de 8 años que consultaron en un servicio de urgencias pediátrico por sospecha de intoxicación farmacológica entre julio 2012 y junio 2018.Se seleccionaron los principios activos responsables comercializados en España y se determinó la dosis letal o la dosis altamente tóxica. Se calculó el número de unidades necesarias para alcanzarla en niños de 10 kg. Resultados: Se identificaron 7 grupos de MAT: analgésicos; psicofármacos y medicamentos neuromusculares; anticatarrales descongestivos-antitusígenos-antihistamínicos-antiasmáticos; medicamentos cardiovasculares; antimicrobianos; preparados tópicos y otros medicamentos. En 29 principios activos, la ingesta de una única unidad podría causar la muerte en un lactante de 10 kg de peso, en 13 podría causarla la ingesta de dos unidades y en 10 la ingesta de tres unidades. Conclusión: Existen numerosos MAT comercializados en España, algunos de ellos disponibles en presentaciones potencialmente letales con pocas unidades.
To prepare a list of highly toxic drugs in infants (HTDs) marketed in Spain, comparing those that reach the lethal dose in a child of 10 kg with the ingestion of one to three units.
HTDs are defined ...as those capable of causing severe or lethal poisoning in children less than 8-year-old. Severe poisoning is considered as that corresponding to Grade 3 in the Poisoning Severity Score classification and to the “major effects” category in publications in the American Association of Poison Control Centers (AAPCC). A literature review was carried out on the annual reports of the AAPCC, as well as in PubMed, between January 2000 and February 2019 (key words: “severe”, “fatal”, “life-threatening”, “poisoning”, “child”, “paediatric”, “toxicological emergency”). An observational, retrospective study was also conducted on infants less than 8-year-old that were seen in a Paediatric Emergency Department due to suspected drug poisoning between July 2012 and June 2018.
The active ingredients responsible marketed in Spain were selected, and the lethal or highly toxic doses were determined. The number of units (pills) necessary to reach this dose in children of 10 kg was calculated.
A total of 7 HTD groups were identified: analgesics; psychotropics and other medication used in neurological disorders; catarrh decongestants – cough –antihistamine – asthma drugs; cardiovascular drugs; antibiotics, topical preparations, and other drugs. In 29 active ingredients, the ingestion of a single pill could cause death in 10 kg infant, in another 13, the ingestion of 2 pills could cause death, as well as the ingestion of 3 pills in 10 cases.
There are numerous HTDs marketed in Spain, some of which are available in potentially fatal presentations with few pills.
Elaborar un listado de medicamentos altamente tóxicos en la infancia (MAT), comercializados en España, diferenciando aquellos que alcanzan la dosis letal para un niño de 10 kg con la ingesta de una a tres unidades.
Se definió MAT como aquellos capaces de producir intoxicaciones graves o letales en niños menores de 8 años. Se consideró toxicidad grave la correspondiente al grado 3 en la clasificación Poisoning Severity Score y a la categoría “major effects” en las publicaciones de la American Association of Poison Control Centers (AAPCC). Se realizó una revisión bibliográfica de los informes anuales de la AAPCC y de PubMed entre enero 2000 y febrero 2019 (palabras clave: “severe”, “fatal”, “life-threatening”, “poisoning”, “child”, “pediatric”, “toxicological emergency”). Además, se realizó un estudio observacional retrospectivo de menores de 8 años que consultaron en un servicio de urgencias pediátrico por sospecha de intoxicación farmacológica entre julio 2012 y junio 2018.
Se seleccionaron los principios activos responsables comercializados en España y se determinó la dosis letal o la dosis altamente tóxica. Se calculó el número de unidades necesarias para alcanzarla en niños de 10 kg.
Se identificaron 7 grupos de MAT: analgésicos; psicofármacos y medicamentos neuromusculares; anticatarrales descongestivos-antitusígenos-antihistamínicos-antiasmáticos; medicamentos cardiovasculares; antimicrobianos; preparados tópicos y otros medicamentos. En 29 principios activos, la ingesta de una única unidad podría causar la muerte en un lactante de 10 kg de peso, en 13 podría causarla la ingesta de dos unidades y en 10 la ingesta de tres unidades.
Existen numerosos MAT comercializados en España, algunos de ellos disponibles en presentaciones potencialmente letales con pocas unidades.
Availability of antidotes in Catalan hospitals: the DISQUATOX survey Gispert Ametller, Maria Àngels; Aguilar Salmerón, Raquel; Jambrina Albiach, Anna María ...
Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias,
10/2023, Letnik:
35, Številka:
5
Journal Article
To identify predictors for developing delayed neurological syndrome (DNS) after an initial episode of carbon monoxide (CO) poisoning in the interest of detecting patients most likely to develop DNS ...so that they can be followed.
Retrospective review of cases of CO poisoning treated in the past 10 years in the emergency departments of 4 hospitals in the AMICO study (Spanish acronym for the multicenter analysis of CO poisoning). We analyzed demographic characteristics of the patients and the clinical characteristics of the initial episode. The records of the cohort of patients with available follow-up information were reviewed to find cases of DNS. Data were analyzed by multivariant analysis to determine the relationship to characteristics of the initial exposure to CO.
A total of 240 cases were identified. The median (interquartile range) age of the patients was 36.2 years (17.6-49.6 years); 108 patients (45.0%) were men, and the poisoning was accidental in 223 cases (92.9%). The median carboxyhemoglobin concentration on presentation was 12.7% (6.2%-18.7%). Follow-up details were available for 44 patients (18.3%). Eleven of those patients (25%) developed DNS. A low initial Glasgow Coma Scale score predicted the development of DNS with an odds ratio (OR) of 0.61 (95% CI, 0.41-0.92) and an area under the receiver operating characteristic curve of 0.876 (95% CI, 0.761-0.990) (P .001).
The initial Glasgow Coma Scale score seems to be a clinical predictor of DNS after CO poisoning. We consider it important to establish follow-up protocols for patients with CO poisoning treated in hospital EDs.
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