Timour Q.,University of Lyon |
Timour Q.,Center Antipoison |
Frassati D.,Center Hospitalier Specialise le Vinatier |
Descotes J.,Center Antipoison |
And 3 more authors.
Frontiers in Pharmacology | Year: 2012
Mortality rate is high in psychiatric patients versus general population. An important cause of this increased mortality is sudden cardiac death (SCD) as a major side-effect of psychotropic drugs. These SCDs generally result from arrhythmias occurring when the posology is high and may attain a toxic threshold but also at dosages within therapeutic range, in the presence of risk factors.There are three kinds of risk factors: physiological (e.g., low cardiac rate of sportsmen), physiopathological (e.g., hepatic insufficiency, hypothyroidism) and "therapeutic" (due to interactions between psychotropic drugs and other medicines). Association of pharmacological agents may increase the likelihood of SCDs either by (i) a pharmacokinetic mechanism (e.g., increased torsadogenic potential of a psychotropic drug when its destruction and/or elimination are compromised) or (ii) a pharmacodynamical mechanism (e.g., mutual potentiation of proarrhythmic properties of two drugs). In addition, some psychotropic drugs may induce sudden death in cases of pre-existing congenital cardiopathies such as (i) congenital long QT syndrome, predisposing to torsade de pointes that eventually cause syncope and sudden death. (ii) A Brugada syndrome, that may directly cause ventricular fibrillation due to reduced sodium current through Nav1.5 channels. Moreover, psychotropic drugs may be a direct cause of cardiac lesions also leading to SCD. This is the case, for example, of phenothiazines responsible for ischemic coronaropathies and of clozapine that is involved in the occurrence of myocarditis. The aims of this work are to delineate: (i) the risk of SCD related to the use of psychotropic drugs; (ii) mechanisms involved in the occurrence of such SCD; (iii) preventive actions of psychotropic drugs side effects, on the basis of the knowledge of patient-specific risk factors, documented from clinical history, ionic balance, and ECG investigation by the psychiatrist. © 2012 Timour, Frassati, Descotes, Chevalier, Christé and Chahine.
PubMed | Center Antipoison, Public Health England, Niguarda Ca Granda Hospital, National Poisons Information Service and 4 more.
Type: | Journal: Environment international | Year: 2016
European legislation requires reporting from Member States on acute poisoning incidents involving pesticides. However, standard rules for data collection and reporting have not yet been set out. The new categorization system presented in this paper is aimed at enabling Member States to gather comparable data and provide standard reporting on pesticide poisoning exposures.European Regulations providing separate official categorization of biocidal and plant protection pesticides, were used as a basis to build up a unified pesticide categorization and coding system. Data on selected pesticide exposures collected by Poison Control Centres in six EU countries were reviewed, categorized and reported according to the proposed system.The resulting pesticide categorization system has two dimensions. The first part identifies the main category of use, i.e. biocide/plant protection pesticide/unknown, and the secondary category of use, e.g. Rodenticides, Insecticides and acaricides. The second part of the system is organized into two levels: level one identifies chemical grouping, e.g. Coumarins, Pyrethrins/pyrethroids, while level two identifies the active compound by using its Chemical Abstract Service Registry Number. The system was used to provide a unified categorization to compare exposures to plant protection and biocidal Rodenticides and Pyrethrins/pyrethroids Insecticides and acaricides identified by six EU member states.The developed pesticide categorization system was successfully applied to data extracted from different databases and was able to make the required information comparable. The data reported filling in common templates containing a pre-ordinate list of active compounds categorized according the proposed system, highlighted different capabilities in data collection and recording, showing that some of the collaborating centres were not able to distinguish between main categories of pesticide products or provide information on active compounds. The results indicate that a special effort should be dedicated to support detailed data recording at national level. Providing common tools to systematically report to the EU Commission hazardous exposures to pesticides, as well as to other selected categories of products, could allow for data comparability between Member States and greatly improve post marketing surveillance and alerting systems in Europe.
Saoudi A.,Institute of Veille Sanitaire |
Zeghnoun A.,Institute of Veille Sanitaire |
Bidondo M.-L.,Institute of Veille Sanitaire |
Garnier R.,Center Antipoison |
And 3 more authors.
Science of the Total Environment | Year: 2012
The French Nutrition and Health Survey (ENNS) was conducted to describe dietary intakes, nutritional status, physical activity, and levels of various biomarkers for environmental chemicals (heavy metals and pesticides) in the French population (adults aged 18-74. years and children aged 3-17. years living in continental France in 2006-2007). The aim of this paper was to describe the distributions of total arsenic and the sum of iAs + MMA + DMA in the general adult population, and to present their main risk factors. In the arsenic study, 1500 and 1515 adults (requested to avoid seafood intake in the previous 3. days preceding urine collection) were included respectively for the analysis of the sum of inorganic arsenic (iAs) and its two metabolites, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), and for the total arsenic. Results were presented as geometric means and selected percentiles of urinary arsenic concentrations (μg/L) and creatinine-adjusted urinary arsenic (μg/g of creatinine) for total arsenic, and the sum of inorganic arsenic and metabolites (iAs + MMA + DMA). The geometric mean concentration of the sum of iAs + MMA + DMA in the adult population living in France was 3.34 μg/g of creatinine [3.23-3.45] (3.75 μg/L [3.61-3.90]) with a 95th percentile of 8.9 μg/g of creatinine (10.68 μg/L). The geometric mean concentration of total arsenic was 11.96 μg/g of creatinine [11.41-12.53] (13.42 μg/L [12.77-14.09]) with a 95th percentile of 61.29 μg/g of creatinine (72.75 μg/L).Urinary concentrations of total arsenic and iAS + MMA + DMA were influenced by sociodemographic and economic factors, and by risk factors such as consumption of seafood products and of wine. In our study, covariate-adjusted geometric means demonstrated several slight differences, due to consumption of fish, shellfish/crustaceans or wine. This study provides the first reference value for arsenic in a representative sample of the French population not particularly exposed to high levels of arsenic (10 μg/g of creatinine). It shows that urinary arsenic concentrations in the French adult population (in particular concentrations of iAs + MMA + DMA) were relatively low compared with foreign data. © 2012 Elsevier B.V.
PubMed | Center antipoison, Texas Tech University Health Sciences Center, University of Paris Descartes, University Paris Diderot and groupe hospitalier Necker
Type: Journal Article | Journal: Annales pharmaceutiques francaises | Year: 2016
Regarding the different disciplines that encompass the pharmacology and the toxicology, none is specifically dedicated to the description and analysis of the time-course of relevant toxic effects both in experimental and clinical studies. The lack of a discipline devoted to this major field in toxicology results in misconception and even in errors by clinicians.Review of the basic different disciplines that encompass pharmacology toxicology and comparing with the description of the time-course of effects in conditions in which toxicological analysis was not performed or with limited analytical evidence.Review of the literature clearly shows how misleading is the current extrapolation of toxicokinetic data to the description of the time-course of toxic effects.A new discipline entitled toxicodynetics should be developed aiming at a more systematic description of the time-course of effects in acute human and experimental poisonings. Toxicodynetics might help emergency physicians in risk assessment when facing a poisoning and contribute to a better assessment of quality control of data collected by poison control centres. Toxicodynetics would also allow a quantitative approach to the clinical effects resulting from drug-drug interaction.
Schmitt C.,Center Antipoison |
de Haro L.,Center Antipoison
Toxins | Year: 2013
Clinical marine toxicology is a rapidly changing area. Many of the new discoveries reported every year in Europe involve ecological disturbances-including global warming-that have induced modifications in the chorology, behavior, and toxicity of many species of venomous or poisonous aquatic life including algae, ascidians, fish and shellfish. These changes have raised a number of public issues associated, e.g., poisoning after ingestion of contaminated seafood, envenomation by fish stings, and exposure to harmful microorganism blooms. The purpose of this review of medical and scientific literature in marine toxicology is to highlight the growing challenges induced by ecological disturbances that confront clinical toxicologists during the everyday job in the European Poison Centers. © 2013 by the authors; licensee MDPI, Basel, Switzerland.
Vial T.,Center antipoison
Therapie | Year: 2016
Pharmacovigilance aims to identify unknown adverse drug reactions once clinical development is complete, in order to promote improved use of drugs, and thus a reduction in risk for every exposed patient. We describe in this article the missions of French pharmacovigilance system, including French drug agency, Regional Centers of Pharmacovigilance, health professionals, pharmaceutical companies, patients and their associations. We also develop the French pharmacovigilance organization, its perspectives and challenges, both in French and European levels. © 2016 Published by Elsevier Masson SAS on behalf of the Société française de pharmacologie et de thérapeutique.
Perinet I.,Service de Medecine Polyvalente |
Lioson E.,Service de Medecine Polyvalente |
Tichadou L.,Center Antipoison |
Glaizal M.,Center Antipoison |
De Haro L.,Center Antipoison
Medecine Tropicale | Year: 2011
Henna (Lawsonia inermis) is a stirub bearing leaves that are crushed and used for cosmetic purposes in Asia and Africa. In .several countries, henna decoction is ingested as a traditional drug to induce abortion. One component of Henna, known as Lawsone, can induce hemolysis in G6PD-deficient patients after cutaneous exposure or ingestion. The purpose of this report is to describe a case of severe hemolytic anemia after voluntary ingestion of Henna decoction to induce abortion. This complication led to diagnosis of partial moderate G6PD-deficiency in the 17-year-old patient living in Mayotte in the Indian Ocean. This report emphasizes the life-threatening hazards associated with some plant extracts used as traditional medicines.
PubMed | Center Antipoison, University of Paris Descartes and Service Of Reanimation Center Hospitalier National Of Fann
Type: | Journal: The journal of venomous animals and toxins including tropical diseases | Year: 2016
Although considered a public health issue in Senegal, the actual incidence and mortality from snakebite are not known. In the present study, an epidemiological survey was carried out in Kdougou region, southeastern Senegal, where envenomations, particularly by Echisocellatus, are frequent and severe.Three sources of data were used: records from health centers and reports by health professionals; traditional healers; and household surveys.The annual incidence and mortality provided by health centers were 24.4 envenomations and 0.24 deaths per 100,000 population, respectively. The annual incidence recorded by traditional healers was 250 bites per 100,000 inhabitants, but the number of deaths was unknown. Finally, the household surveys reported an annual incidence of 92.8 bites per 100,000 inhabitants and an annual mortality rate of 2.2 deaths per 100,000 inhabitants. The differences in incidence and mortality between the different methods were explained by significant bias, resulting in particular from the complex patients healthcare-seeking behavior. The incidence provided by health records should be used to specify the immediate quantitative requirements of antivenoms and places where they should be available first.Mandatory reporting of cases would improve the management of envenomation by simplifying epidemiological surveys. Patients preference for traditional medicine should prompt health authorities to urge traditional healers to refer patients to health centers according to defined clinical criteria (mainly edema and bleeding or neurotoxic symptoms). Finally, household surveys were likely to reflect the actual epidemiological situation. Poison Control Center of Senegal should continue its work to sensitize stakeholders and train health staff.
PubMed | Center antipoison
Type: Journal Article | Journal: Therapie | Year: 2016
Pharmacovigilance aims to identify unknown adverse drug reactions once clinical development is complete, in order to promote improved use of drugs, and thus a reduction in risk for every exposed patient. We describe in this article the missions of French pharmacovigilance system, including French drug agency, Regional Centers of Pharmacovigilance, health professionals, pharmaceutical companies, patients and their associations. We also develop the French pharmacovigilance organization, its perspectives and challenges, both in French and European levels.
Basselin C.,Center Antipoison |
Fontanges T.,Center Hospitalier Pierre Oudot |
Descotes J.,Center Antipoison |
Bui-Xuan B.,French Institute of Health and Medical Research |
And 3 more authors.
Pharmacotherapy | Year: 2011
Tako-Tsubo cardiomyopathy (also known as apical ballooning syndrome) is a relatively new clinical entity characterized by reversible left ventricular dysfunction. Its clinical presentation and electrocardiographic findings are similar to acute myocardial infarction but without significant coronary artery disease. Cardiotoxicity is a major complication of various anticancer drugs; however, only a few cases of Tako-Tsubo cardiomyopathy associated with anticancer drugs, including 5-fluorouracil, have been reported. We describe a 48-year-old man who developed acute coronary syndrome, thought to be similar to Tako-Tsubo syndrome, after receiving a chemotherapy regimen consisting of 5-fluorouracil, oxaliplatin, and calcium folinate (FOLFOX protocol) for colic adenocarcinoma. Approximately 24 hours after receiving his first cycle of chemotherapy, the patient, who did not have a history of cardiovascular disease, developed chest pain, with abnormal electrocardiographic results and a mildly increased troponin T level. Coronary angiography did not show any significant coronary lesions. Echocardiography revealed marked left ventricular dysfunction (left ventricular ejection fraction [LVEF] 15%) with severe hypokinesia in all apical and median segments. The patient was stabilized with the introduction of an intraaortic balloon pump and pressor therapy. One month later, myocardial magnetic resonance imaging confirmed total recovery of left ventricular systolic function. Thus, the second chemotherapy cycle was administered at half the dose-intensity, along with ramipril and diltiazem. The chemotherapy regimen was well tolerated. Two weeks later, at the end of the third chemotherapy cycle, administered using the full-dose regimen, the patient experienced cardiac arrest, necessitating cardiopulmonary resuscitation. After transfer to the cardiology intensive care unit, acute heart failure recurred (LVEF 35%). Normal recovery of left ventricular function occurred a few days later. Chemotherapy was discontinued, and treatment with bisoprolol was started. Four months later, the patient remained completely asymptomatic of any cardiac manifestations. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 8) between the patient's development of acute coronary Tako-Tsubo - like syndrome and 5-fluorouracil. Clinicians should be aware of this potential adverse effect when monitoring patients receiving chemotherapy with 5-fluorouracil.