Review of the demographic pattern and outcomes of acute chemical poisoning in patients in a tertiary hospital in South-western Nigeria

Introduction: Acute chemical poisoning is a public health problem especially in developing countries where there is unrestricted access to chemical products, underreporting and absence of poisoning registers. Despite its importance, there is limited information on acute poisoning among adult population in Nigeria. The study was aimed at determining the demographic pattern and short term outcomes of acute chemical poisoning in patients in a tertiary health institution in South-western Nigeria over a 2 year period.Methodology: Records of cases of acute chemical poisoning over a 2-year period were retrieved and the following information extracted: socio-demographic data of patient, type of substance ingested, type of poisoning, reason for poisoning, intervention, and outcome of treatment. Results:There were 58 patients with a M:F ratio of 1:1.1. The mean age was 28.53±13.47 years. The most commonly ingested chemical was organophosphate seen in 31(53.4%). Poisoning was deliberate in 43 (74.1%); 36 patients (62.1%) had atropine; 16 patients (27.6%) had gastric lavage; one patient (1.7%) was dialyzed and 2 patients (3.4%) were admitted into ICU. Mortality rate was 8.6%. Conclusion: Deliberate acute chemical poisoning was common in young adults. Organophosphate is the most commonly ingested chemical. Government should enforce laws that that would restrict access to potentially harmful chemicals. French title: Schéma et résultats à court terme d'une intoxication chimique aiguë dans un hôpital tertiaire du sud-ouest du Nigéria Introduction : Les intoxications chimiques aiguës sont un problème de santé publique en particulier dans les pays en développement où il existe un accès illimité aux produits chimiques, une sous-déclaration et l'absence de registres des intoxications. Malgré son importance, il existe peu d'informations sur les intoxications aiguës parmi la population adulte au Nigéria.Objectif de l'étude: Déterminer le schéma démographique et les résultats à court terme des intoxications chimiques aiguës chez les patients d'un établissement de santé tertiaire du sud-ouest du Nigéria sur une période de 2 ans.Méthode de l'étude : Des dossiers de cas d'intoxication chimique aiguë sur une période de 2 ans ont été récupérés et les informations suivantes extraites : données sociodémographiques du patient, type de substance ingérée, type d'intoxication, raison de l'intoxication, intervention et résultat du traitement.Résultat de l'étude : Il y avait 58 patients avec un rapport M : F de 1:1,1. L'âge moyen était de 28,53 ± 13,47 ans. Le produit chimique le plus couramment ingéré était l'organophosphate vuswzsw3 dans 31 (53,4 %). L'empoisonnement était délibéré dans 43 (74,1 %); 36 patients (62,1%) avaient de l'atropine ; 16 patients (27,6 %) ont eu un lavage gastrique ; un patient (1,7%) a été dialysé et 2 patients (3,4%) ont été admis en réanimation. Le taux de mortalité était de 8,6%. Conclusion : Les intoxications chimiques aiguës délibérées étaient fréquentes chez les jeunes adultes. L'organophosphate est le produit chimique le plus couramment ingéré. Le gouvernement devrait appliquer des lois qui restreindraient l'accès aux produits chimiques potentiellement nocifs.

Pharmacy services for the 2019 Fédération Internationale de Natation (FINA) World Masters Championships in Gwangju, South Korea

Background The role of sports pharmacists is being emphasized in international athletic events. This study aimed to describe the pharmacy services for the 2019 Fédération Internationale de Natation (FINA) World Masters Championships in Gwangju, South Korea. Method Research focused on athletes and coaching staff who received medications after visiting medical centers and pharmacies located in the athletes’ village from July 5 to July 29, 2019. We collected daily results of pharmacy operation and prescription interventions. The data were analyzed using Microsoft Excel, and were expressed as frequency (%). Results Throughout the tournament, 633 patients received medication at the athletes’ village pharmacy (gender: 338 men [53.4%], 295 women [46.6%]; nationality: 299 Korean [47.2%], 334 overseas players [52.8%]; patient type: 150 athletes [23.7%], 427 non-athletes [67.5%]). Therapy for musculoskeletal disorders was the most common (n = 29, 19.3%), and oral NSAIDs (n = 56, 22.0%) were the most frequently dispensed medication in athletes. Pharmacists intervened for 47 out of 491 prescriptions (9.6%), with dosage change (n = 21, 44.7%) being the most common intervention type. Conclusion Sports pharmacists at FINA World Masters Championships played a pivotal role in ensuring the safe usage of medications by all participants, especially athletes. This study results will be a useful reference for pharmacy services at future international or domestic sports competitions.

Patient-Type Bayes-Adaptive Treatment Plans

Treatment decisions that explicitly consider patient heterogeneity can lower the cost of care and improve outcomes by providing the right care for the right patient at the right time. “Patient-Type Bayes-Adaptive Treatment Plans” analyzes the problem of designing ongoing treatment plans for a population with heterogeneity in disease progression and response to medical interventions. The authors create a model that learns the patient type by monitoring patient health over time and updates a patient's treatment plan according to the information gathered. The authors formulate the problem as a multivariate state space partially observable Markov decision process (POMDP). They provide structural properties of the optimal policy and develop several approximate policies and heuristics to solve the problem. As a case study, they develop a data-driven decision-analytic model to study the optimal timing of vascular access surgery for patients with progressive chronic kidney disease. They provide further policy insights that sharpen existing guidelines.

730 Establishing Thresholds for Clinically Significant Donor Skin Reduction – Initial Findings from a Physician Delphi Consensus Panel

Introduction Definitive closure with autograft, as a current standard of care, is a critical outcome in severe burn treatment. Harvest of donor skin for autograft is associated with pain, scarring and potential infection. New treatment modalities aim to reduce the amount of donor skin required to achieve definitive closure of the burn wound. A threshold that defines the clinically significant reduction in amount of harvested skin for the treatment of deep partial (DPT) and full-thickness (FT) burns is not available. This study convened a Delphi Consensus Panel (DCP) to determine this threshold. The DCP is an accepted method to synthesize opinions and feedback from experts and to systematically achieve consensus. Methods Panel members were burn physicians with ≥3 years of experience post-residency, with either a total career experience of caring for ≥1,000 patients or working in a facility with an annual volume of ≥200 patients and caring for ≥500 patients. Round 1 consisted of open-ended questions regarding clinical decision-making, use of skin substitutes (SS) in DPT and FT burn treatment, and what would constitute a clinically significant reduction in donor skin. Results Panelists reported using SS to promote healing and achieve definitive closure without autograft for DPT burns, and as a temporizing measure between excision and surgery for FT burns. Total body surface area (TBSA) affected by burn and burn location influenced SS use. For DPT and FT burns, other patient outcomes influencing treatment decisions were cosmesis, pain control, and reducing functional limitations. Almost all panelists reported that reduction in the amount of donor skin were important. As expected in Round 1, a range for the minimum percentage of donor skin reduction regarded as clinically significant was provided for DPT (20%-50%) and FT (10%-20%) burns. The main factors influencing these estimates were TBSA burned, patient outcomes, patient preference, and patient type. Final results will provide consensus estimates for clinical significance for donor skin reduction based on subsequent rounds. Conclusions Preliminary results indicate that reduction of the amount of donor skin is important to physicians with burn care experience, and the thresholds for clinical significant reduction in donor skin are influenced by patient outcomes and preferences, TBSA burned, and patient type. Applicability of Research to Practice These data will provide a research-based definition surrounding the clinical significance of new treatment modalities for severely burned patients.

ANALYSIS PLATELET INDICES IN PATIENT TYPE 2 DIABETES MELLITUS WITH VASCULAR COMPLICATION

ANALYSIS PLATELET INDICES IN PATIENT TYPE 2 DIABETES MELLITUS WITH VASCULAR COMPLICATION Nelly1, Suci Aprianti2 ,Darmawaty ER31Medical Doctor Specialist Education Program of Clinical Pathology, Faculty of Medicine, Hasanuddin University/Dr. Wahidin Sudirohusodo hospital, Makassar2Departement of Clinical Pathology, Faculty of Medicine, Hasanuddin University3Departement of Clinical Pathology, Faculty of Medicine, Hasanuddin University /Dr. Wahidin Sudirohusodo Hospital, Makassar ABSTRACT Introduction :Type 2 Diabetes Mellitus(T2DM) is an endocrin disease that is marked by hyperglycemic condition due to a decrease increase in insulin secretion and insulin resistance or both. Indonesia is the 7th country with the highest incidence of diabetes mellitus in the world. Progression of the disease is slow and cause vascular endothelial damage. The increase of platelet indices is suspected to be an indications of vascular complicationsObjective :To evaluate the platelet indices in diabetics patients with complication and correlate these indices with GDP and HbA1c. Materials and methods :We analyzed platelet indices and biochemical data of patients seen in outpatients by clinicans of wahidin soedirohusodo hospitals. 120 patients with type 2 diabetes mellitus were included with 64 patients vascular complication and 56 patients without complication.Result :We observed an increase in mean platelet volume (MPV): 9,96 + 1.99vs 8.87 + 1.35(p-value: 0,001) ;in platelet distribution width (PDW): 15.29 + 3.45 vs 12.36 + 2.819(p-value: 0,000; without increase plateletcrit (PCT); 0.28 + 0.14 vs 0.25 + 0.12 (p-value: 0.168). we observed a correlation between FBG with PDW (P=0.044).Conclusion :The study findings point to the significant differences in platelet indices (MPV and PDW) in patients with T2DM with complication and without complication, suggesting the presence of platelet in diabetics type 2 patients more reactive and aggregatable in this group of individuals. These suggest that platelet evaluation may be useful in the early detection of long term complication in diabetics patients.Keyword :T2DM, platelet indices, complication vascular