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Articles 31 - 60 of 156
Full-Text Articles in Medicine and Health Sciences
A Pandora's Box: Sustainable Pharmaceutical Supply, Alison Jones, Rosemary James, Lisa Harris, Forbes Mcgain, Simon Quilty, Robert Pearce, Jacquellne Kewley
A Pandora's Box: Sustainable Pharmaceutical Supply, Alison Jones, Rosemary James, Lisa Harris, Forbes Mcgain, Simon Quilty, Robert Pearce, Jacquellne Kewley
Alison L Jones
No abstract provided.
Digoxin Immune Fab, Alison Jones, Robert Flanagan
Digoxin Immune Fab, Alison Jones, Robert Flanagan
Alison L Jones
No abstract provided.
Paracetamol (Acetaminophen) Overdose, Alison Jones
Paracetamol (Acetaminophen) Overdose, Alison Jones
Alison L Jones
A 23-year-old woman. who is 34 weeks pregnant with her first child, is seen In the Emergency Department after taking 28 paratetamol (500 mg) tablets 2 h ago. She is 62 kg in weight. She did not co-ingest any other drug or alcohol. She complains of nausea and intermittent vomiting. but this has been consistent throughout her pregnancy.
Measuring Plasma Salicylate Concentrations In All Patients With Drug Overdose Or Altered Consciousness: Is It Necessary?, David Wood, Paul Dargan, Alison Jones
Measuring Plasma Salicylate Concentrations In All Patients With Drug Overdose Or Altered Consciousness: Is It Necessary?, David Wood, Paul Dargan, Alison Jones
Alison L Jones
Background: Salicylate self poisoning is potentially fatal. Plasma salicylate concentrations can be used to guide management when taken in the context of clinical features of toxicity and acid base status. Previous studies in the USA and Hong Kong have shown that routine measurement of plasma salicylate concentrations in all overdose patients is inappropriate, but there have been no previous studies in the UK. Methods: A retrospective case note study from 1 February 2001 to 31 January 2002 was undertaken at the emergency department of St. Thomas’ Hospital, London. Records were reviewed and information on demographic data, history, details of salicylate …
A Young Woman Who Has Taken An Overdose Of Paracetamol (Acetaminophen), Alison Jones
A Young Woman Who Has Taken An Overdose Of Paracetamol (Acetaminophen), Alison Jones
Alison L Jones
No abstract provided.
Adverse Drug Reactions To Poison Antidotes: Part 2, Alison Jones
Adverse Drug Reactions To Poison Antidotes: Part 2, Alison Jones
Alison L Jones
Administration of antidotes such as dicobalt edetate in cyanide poisoning or dimercaprol in arsenic poisoning carries a high risk of adverse reactions, and the clinical decision to use the antidote is only taken in severe poisoning. Supportive measures such as ventilation may be required in addition to the antidote. In pregnancy, it is usually reasoned that treatment of the mother takes precedence and provides the best chance for fetal survival, notwithstanding worries about teratogenicity.
Drug Interactions With Paracetamol, M Toes, Alison Jones, L Prescott
Drug Interactions With Paracetamol, M Toes, Alison Jones, L Prescott
Alison L Jones
Paracetamol (acetaminophen) is one of the most commonly used analgesic antipyretic drugs worldwide, and it is widely available by prescription and over the counter (OTC). Fortunately, few clinically significant drug interactions have been documented. There is probable potentiation of hepatotoxicity following an overdose from the paracetamol metabolite NAPQI by enzyme-inducing drugs. There is considerable controversy regarding the possible interaction with warfarin in its potential to increase its anticoagulant effects because of discrepancies between observational studies and those in healthy volunteers. Otherwise, no serious adverse drug interactions with therapeutic doses of paracetamol have been confirmed in humans. Because the absorption of …
Plasma Salicylate Concentrations Following Overdose; Are They Worth It ?, David Muir Wood, Alison Jones, Paul Dargan
Plasma Salicylate Concentrations Following Overdose; Are They Worth It ?, David Muir Wood, Alison Jones, Paul Dargan
Alison L Jones
Treatment following salicylate ingestion is determined by clinical evidence of toxicity. Previous studies have shown that routine measurement of plasma salicylate concentrations in all overdose patients is unnecessary except in those with clinical features suggestive of salicylate poisoning or in those who are unable to give an accurate history [1]. This retrospective study evaluates whether plasma salicylate concentrations are appropriately measured. A retrospective study of all plasma salicylate concentrations measured in St Thomas’ Hospital Accident and Emergency department from 1 February 2001 to 31 January 2002 was conducted. Admission record cards were surveyed for history of salicylate ingestion, clinical features …
Risk Of Road Traffic Accidents In Patients Discharged Following Treatment For Psychotropic Drug Overdose: A Self-Controlled Case Series Study In Australia, Tharaka L. Dassanayake, Alison L. Jones, Patricia Michie, Gregory Carter, Patrick Mcelduff, Barrie J. Stokes, Ian Whyte
Risk Of Road Traffic Accidents In Patients Discharged Following Treatment For Psychotropic Drug Overdose: A Self-Controlled Case Series Study In Australia, Tharaka L. Dassanayake, Alison L. Jones, Patricia Michie, Gregory Carter, Patrick Mcelduff, Barrie J. Stokes, Ian Whyte
Alison L Jones
Background: Use of psychotropic drugs is known to impair driving and increase the risk of road traffic accidents. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. Most patients who take psychotropic drug overdoses are discharged within 48 hours, while they still have possible subclinical drug effects. Objective: Using a self-controlled case series design, we aimed to determine whether patients with psychotropic drug overdose are at a higher risk of a traffic accident in the period following discharge compared with a control period not associated with hospital-treated drug overdose. Methodology: Using the New South …
Hepatocellular Damage Following Therapeutic Intravenous Iron Sucrose Infusion In A Child, David Wood, Alison Thomson, Matthew Lawes, Alison Jones, Paul Dargan
Hepatocellular Damage Following Therapeutic Intravenous Iron Sucrose Infusion In A Child, David Wood, Alison Thomson, Matthew Lawes, Alison Jones, Paul Dargan
Alison L Jones
The maximum tolerated single dose of intravenous iron infusion and iron pharmacokinetics are not known in children and not clear in adults. The case reported here is of a child given a large dose of intravenous iron sucrose (16 mg/kg) over 3 hours, who subsequently developed features of systemic iron toxicity. A TDM consultant discusses the case in the context of toxicokinetic analysis. Because the maximum tolerated dose and pharmacokinetics of intravenous iron preparations are not known, their use in both adults and children should still be undertaken with caution.
Determinants Of Paramedic Response Readiness For Cbrne Threats, Garry Stevens, Alison Jones, George Smith, Jenny Nelson, Kingsley Agho, Melanie Taylor, Beverley Raphael
Determinants Of Paramedic Response Readiness For Cbrne Threats, Garry Stevens, Alison Jones, George Smith, Jenny Nelson, Kingsley Agho, Melanie Taylor, Beverley Raphael
Alison L Jones
Paramedics play a pivotal role in the response to major emergencies. Recent evidence indicates that their confidence and willingness to respond to chemical, biological, radiological, nuclear, and explosives-related (CBRNE) incidents differs from that relating to their "routine" emergency work. To further investigate the factors underpinning their readiness to respond to CBRNE incidents, paramedics in New South Wales (NSW), Australia, were asked to complete a validated online survey instrument. Univariate and multivariate analyses were performed to examine associated factors determining readiness. The sample of 663 respondents was weighted to reflect the NSW paramedic population as a whole. The univariate analysis indicated …
Multiple Toxicity From 3,4-Methylenedioxymethamphetamine ("Ecstasy"), S Greene, Paul Dargan, Niall O'Connor, Alison Jones, Mary Kerins
Multiple Toxicity From 3,4-Methylenedioxymethamphetamine ("Ecstasy"), S Greene, Paul Dargan, Niall O'Connor, Alison Jones, Mary Kerins
Alison L Jones
There have been no published case series illustrating “ecstasy” (3,4-methylenedioxymethamphetamine [MDMA]) toxicity in a group of patients who have ingested ecstasy in the same environment. We report a series of 7 patients who ingested ecstasy in a nightclub and presented with varying degrees of MDMA toxicity. Three patients presented with features of severe MDMA toxicity. One died within an hour of hospital admission, another died 4 days later, after developing fulminant hepatic failure, and the third recovered after 12 days in intensive care. MDMA was identified in the serum of all 7 patients. High serum MDMA concentrations correlated with severe …
Should Methionine Be Added To Every Paracetamol Tablet?, Alison Jones, P Hayes, A Proudfoot, J Vale, L Prescott
Should Methionine Be Added To Every Paracetamol Tablet?, Alison Jones, P Hayes, A Proudfoot, J Vale, L Prescott
Alison L Jones
Paracetamol is commonly used for self poisoning, and the costs of treating the resulting liver failure in the few who develop it are high. The morbidity could be avoided by adding methionine to paracetamol tablets, but this would mean that the millions of people who take paracetamol responsibly would have to take methionine unnecessarily. Alison Jones and colleagues and Edward Krenzelok debate the issue.
A Patient With Neurosyphilis Presenting As Chorea, Alison Jones, I.A.D Bouchier
A Patient With Neurosyphilis Presenting As Chorea, Alison Jones, I.A.D Bouchier
Alison L Jones
Despite the marked decline infrequency of neurosyphilis over the past three decades in the United Kingdom, new cases continue to appear both sporadically and as a complication of HIV infection. There is clinical evidence that neurosyphilis is becoming less typical. We describe a case of neurosyphilis presenting predominantly with choreoathetosis and associated hemiparesis in an otherwise healthy, immunocompetent patient. Only six cases of neurosyphilis presenting with features of basal ganglia damage have been reported in the recent literature, five of whom had HIV infection.
Management Of Self Poisoning, Alison L. Jones, Glyn Volans
Management Of Self Poisoning, Alison L. Jones, Glyn Volans
Alison L Jones
Around 15%20% of the workload of medical units and 10% of the workload of accident and emergency departments in the United Kingdom are due to self poisoning.1 2 Episodes of self poisoning in the United Kingdom continue to rise, particularly in young men, and alcohol is often taken with the overdose.2 In general the severity of poisoning has diminished over the past 10 years with the introduction of safer drugs, such as newer serotonin reuptake inhibitors, but the total number of deaths from poisoning in the United Kingdom remains steady at 4000 per year, and the commonest cause of death …
Fulminant Hepatic Failure Due To Diclofenac Treated Successfully By Orthotopic Liver Transplantation, Alison Jones, T Latham, T Shallcross, K Simpson
Fulminant Hepatic Failure Due To Diclofenac Treated Successfully By Orthotopic Liver Transplantation, Alison Jones, T Latham, T Shallcross, K Simpson
Alison L Jones
A 62-year-old woman had received Arthrotec® (containing diclofenac and misoprostol) 50 mg three times per day for two months for treatment of a painful left heel. She subsequently developed fulminant hepatic failure for which viral and auto-immune etiologies were excluded. Other drugs or chemical exposures were also excluded. She developed five out of five poor prognostic criteria for nonparacetamol drug-induced fulminant hepatic failure and underwent successful orthotopic liver transplantation from which she made an excellent recovery. This is the first report of successful treatment of diclofenac-induced fulminant hepatic failure. Four similar cases reported previously in the literature have died without …
Fellows And Members Survey Of The Royal College Of Physicians Of Edinburgh, Alison Jones, S Lewis, D Doyle, R Agius, D Lawson
Fellows And Members Survey Of The Royal College Of Physicians Of Edinburgh, Alison Jones, S Lewis, D Doyle, R Agius, D Lawson
Alison L Jones
No abstract provided.
Mercury: Answering Some Of The Current Controversies About It, David M. Wood, Paul I. Dargan, Alison L. Jones
Mercury: Answering Some Of The Current Controversies About It, David M. Wood, Paul I. Dargan, Alison L. Jones
Alison L Jones
Recently there has been a lot of interest in the medical and lay press concerning exposure to mercury and its potential toxic effects. Mercury is a naturally occurring metallic element, which can be found as Hg or inorganic and organic salts. In this article we will review the risks of exposure and toxicity of each of the forms of mercury, including some of the current guidance concerning the risks of mercury toxicity from eating fish, dental amalgam and vaccinations containing mercury (thiomersal) preservatives.
Collapse, Reported Seizure-And An Unexpected Pill, David Wood, Paul Dargan, Jennifer Button, David Holt, Hanna Ovaska, John Ramsey, Alison Jones
Collapse, Reported Seizure-And An Unexpected Pill, David Wood, Paul Dargan, Jennifer Button, David Holt, Hanna Ovaska, John Ramsey, Alison Jones
Alison L Jones
In May, 2006, on a Bank Holiday weekend, an 18-year-old woman presented to an inner-city London emergency department. She had been at a nightclub with friends and purchased tablets, which she understood to be Ecstasy or amfetamines, from a dealer. After ingesting fi ve tablets, she collapsed in the nightclub and appeared to have a seizure lasting 10 min. On arrival in the emergency department, she was agitated and had dilated pupils (8 mm), sinus tachycardia (156 bpm), and a blood pressure of 150/51 mm Hg. Her score on the Glasgow coma scale was 15 and she was apyrexial (35·9°C). …
Severe Hypokalaemic Metabolic Alkalosis Following Ingestion Of Gaviscon, I Gawarammana, J Coburn, S Greene, Paul Dargan, Alison Jones
Severe Hypokalaemic Metabolic Alkalosis Following Ingestion Of Gaviscon, I Gawarammana, J Coburn, S Greene, Paul Dargan, Alison Jones
Alison L Jones
Uncommon metabolic abnormalities in the emergency department could be a result of drug overdose due to uncommon agents. Case report. A 35-year-old male presented to the emergency department with a Glasgow Coma Scale (GCS) of 3/15 and a normal pulse rate and blood pressure. Subsequent questioning after recovery revealed he had ingested 2 L of Gaviscon® over the preceding 48 hours. He had normal haematology, liver, and renal function during admission. The electrocardiogram showed T wave inversion in the inferior leads on admission. Arterial blood gas on air was: pH 7.54, HCO3 50 mmol/L (50 meq/L), Chloride 66 mmol/L, anion …
Should All Patients With Unexplained Anaemia Be Screened For Chronic Lead Poisoning?, I Gawarammana, Paul Dargan, S Woodcock, M Sculley, Ivan House, David Wood, Alison Jones
Should All Patients With Unexplained Anaemia Be Screened For Chronic Lead Poisoning?, I Gawarammana, Paul Dargan, S Woodcock, M Sculley, Ivan House, David Wood, Alison Jones
Alison L Jones
No abstract provided.
Portal And Systemic Haemodynamic Response To Acute And Chronic Administration Of Low And High Dose Isosorbide-5-Mononitrate In Patients With Cirrhosis, Alison Jones, I Bangash, James Walker, K Simpson, N Finlayson, P Hayes
Portal And Systemic Haemodynamic Response To Acute And Chronic Administration Of Low And High Dose Isosorbide-5-Mononitrate In Patients With Cirrhosis, Alison Jones, I Bangash, James Walker, K Simpson, N Finlayson, P Hayes
Alison L Jones
Oral isosorbide-5-mononitrate (Is-5-Mn) was given in doses of 10 and 40 mg acutely and chronically (twice daily for four weeks), allowing a nitrate free interval to 25 patients with cirrhosis. Both 10 mg and 40 mg Is-S-Mn reduced the hepatic venous pressure gradient acutely and chronically, without evidence of tolerance. This was achieved by a reduction in the wedged hepatic venous pressure. The effect on mean azygos blood flow was variable with no significant mean change seen acutely or after chronic use with either dose. The variability was dependent not on the dose used but on the initial azygos flow; …
Dimercaprol, Alison Jones, Robert Flanagan
Atypical Antipsychotics Not Recommended For Control Of Agitation In The Emergency Department [10], K Whelan, Paul Dargan, Alison Jones
Atypical Antipsychotics Not Recommended For Control Of Agitation In The Emergency Department [10], K Whelan, Paul Dargan, Alison Jones
Alison L Jones
We read with concern the article by Yildiz et al, regarding the recommended use of atypical antipsychotics for the control of agitated patients in the emergency department.1 Our concern rests mainly with the control of agitation secondary to drug ingestion, particularly sympathomimetic drugs of misuse (cocaine, MDMA ‘‘ecstasy’’, and amphetamines), and antidepressants (SSRIs, tricyclic antidepressants, MAOIs).
The Authors Reply, N.T.C Athuraliya, T.D.J Abeysekera, P Amerasinghe, R.P.V Kumarasiri, P Bandara, U Karunaratne, A Milton, Alison Jones
The Authors Reply, N.T.C Athuraliya, T.D.J Abeysekera, P Amerasinghe, R.P.V Kumarasiri, P Bandara, U Karunaratne, A Milton, Alison Jones
Alison L Jones
No abstract provided.
Methionine Risks Not Established, Alison Jones
Calcium Salts, Alison Jones, Robert Flanagan
Insufficient Evidence That Agitation Is Common In Y-Hydroxybutyrate Toxicity, David Wood, Indika Gawarammana, Shaun Greene, Paul Dargan, Alison Jones
Insufficient Evidence That Agitation Is Common In Y-Hydroxybutyrate Toxicity, David Wood, Indika Gawarammana, Shaun Greene, Paul Dargan, Alison Jones
Alison L Jones
Zvosec and Smith have reported that agitation is common in patients who present with c-hydroxybutyrate (GHB) toxicity. Previously, many clinicians would be aware that people withGHBtoxicity typically present with sedation, respiratory depression, and, potentially, coma if severely intoxicated. The authors’ finding that agitation is common in patients with GHB toxicity should alert physicians to other previously unreported potential clinical manifestations of GHB intoxication or to consider intoxication with other agents that cause agitation, such as amphetamine derivatives. However, the data the authors have presented from their observational study do not support their conclusion that agitation is common in people with …
Paracetamol: Balancing Risk Against Benefit, Paul Dargan, Alison Jones
Paracetamol: Balancing Risk Against Benefit, Paul Dargan, Alison Jones
Alison L Jones
No abstract provided.
Comparison Of Assays For Measuring Plasma Paracetamol. Possibility Of Calibration Error Needs Evaluation, Alison L. Jones, D R. Jarvie, D Simpson, L F. Prescott
Comparison Of Assays For Measuring Plasma Paracetamol. Possibility Of Calibration Error Needs Evaluation, Alison L. Jones, D R. Jarvie, D Simpson, L F. Prescott
Alison L Jones
Egleston et al report a significant difference in plasma paracetamol concen trations assayed with the AcetaSite bench assay and a standard laboratory assay. Rapid and accurate determinations of plasma paracetamol concentrations are crucial in the expeditious and appropriate administration of antidotal treatment, which prevents severe liver damage if given sufficiently early in the course of poisoning.