Biomedical subjects

J Aronis

Publications and source records attributed to J Aronis.

5 recordsLinked to original sources

PubMed1999

Dieffenbachia species exposures: an evidence-based assessment of symptom presentation.

The literature often ascribes significant morbidity to Dieffenbachia exposures. However, poison center experience suggests a discordant view from that presented in the literature. This project determined if the symptoms described in the literature were consistent with clinical practice. To profile the symptoms reported in the literature, an extensive literature search using Medline and Webspirs (http:/(/)infoshare.library.pitt.edu/webspirs /webspirs.htm) was conducted to identify publications that described Dieffenbachia toxicity. Standard toxicology references and medical botany texts found in poison centers were used to profile symptoms in the tertiary literature; and an Internet search using the Savvy Search program (http:/(/)www.guaraldi.cs.colostate.edu:20 00) to search simultaneously all other search engines. The symptom information was compared to AAPCC TESS (1993-1996) symptom data reported on Dieffenbachia exposure reports. Twenty-three reference sources profiled the literature perspective on Dieffenbachia exposures. AAPCC TESS contained 10,796 Dieffenbachia exposures, and 34.7% of the reports documented symptoms. Oral irritation was reported in 18.2% of the reports and 92.6% of the queried literature listed this symptom (18.2%/92.6%). Additionally dermal pain = 8.7%/63.0%; vomiting = 2.6%/18.5%; erythema = 2.5%/5.3%; throat irritation = 2.3%/22.2%; dermal edema = 2.2%/3.7%; pruritus = 2.1%/7.4%; ocular irritation = 1.7%/44.4%; rash = 1.2%/29.6%; cough/choke = 1.1%/3.7%; loss of speech = 0%/29.6%; salivation = 0%/29.6%; respiratory obstruction = 0%/48.1%; death = 0%/11.18%. When multiple symptoms occurred the most common toxidrome was oral and throat irritation that occurred in 2.9% of the AAPCC TESS reports. There is similarity between the literature and the clinical experience with regard to the irritant properties of Dieffenbachia species, but there is also significant disparity because the literature fails to put the symptoms into a clinical frequency perspective. In general, the literature portrays Dieffenbachia exposures associated with more morbidity and mortality than what was reported in the AAPCC TESS clinical practice data.

Data Collection↗

PubMed1998

Is the yew really poisonous to you?

BACKGROUND: Taxus species, commonly referred to as yew plants, have the reputation of being inordinately toxic. Case reports which chronicle human near-fatal yew berry ingestions and countless fatalities in livestock present a sober profile to the treating toxicologist. Very often, a limited number of adverse reports influence decisions on all exposures to that potential poison. The objective of this investigation was to profile the toxicity of exposures to Taxus spp and determine what percentage of exposures were associated with significant morbidity. METHODS: The individual computerized files of all exposures to Taxus spp were retrieved from American Association of Poison Control Centers (AAPCC) Toxic Exposure Surveillance System (TESS) and placed in a relational database. Reports from 1985-1994 were analyzed. The cases were examined to determine patient demographics, the outcome of exposures, the ultimate disposition of the patients, treatment, and symptoms. AAPCC TESS definitions were used to assess outcomes. RESULTS: The number of exposures identified from the 10-year subset was 11,197. Children less than 12 years of age were involved in 96.4% (< 6 years 92.7%; 6-12 years, 3.7%) of the exposures. When the final outcome of the exposure was documented (n = 7269), no adverse effects occurred in 92.5% and minor effects were experienced in 7.0%. Moderate (more pronounced, but not life-threatening) effects were experienced by 30 individuals and major (life-threatening) effects occurred in 4 people. There were no fatalities. Decontamination therapy, when compared to no therapy, had no impact on patient outcome. 6.3% were admitted for psychiatric or medical care. When symptoms were related to Taxus spp exposures, the most frequent symptoms were gastrointestinal (65.5%), followed by dermal (8.3%), neurological (6.0%), and cardiovascular (6.0%). DISCUSSION: There are limitations to the interpretation of AAPCC TESS data which may lead to bias in favor of positive outcomes. However, the large sample size may minimize the limitations. CONCLUSION: Taxus spp exposures result only rarely in significant morbidity. Consistent with published case reports, the most common symptoms were gastrointestinal. Decontamination had no impact on patient outcome.

Adolescent↗

PubMed1998

Those pesky berries ... are they a source of concern?

Plant exposures constitute the 4th most common call to poison information centers. Within the plant category, exposures to unidentified berries are common and often create panic in the public and indecisiveness by health professionals. Are exposures to unidentified berries associated with morbidity and mortality? Can these berry exposures be managed at home or do they necessitate medical evaluation? The AAPCC Toxic Exposure Surveillance System was queried to identify exposures with the "unidentified berry" code for a 10-y period. Data parameters included frequency, age, outcome, patient disposition, referral pattern, symptom progression and therapeutic intervention. The data were analyzed using descriptive statistics. Unidentified berry exposures included 11,237 incidents, making it the 11th most common plant-related exposure. Children < 6 y-of-age accounted for 88.5% of the exposures, and 88.5% occurred during June-October. There were no fatalities, and morbidity included 1 major outcome in an infant and 26 exposures with moderate outcomes. In exposures with a known outcome, no effects (86.0%) and minor effects (13.6%) accounted for 99.6% of exposures. When a patient was initially asymptomatic, 89.7% did not develop symptoms and 10.2% progressed to have minor symptoms, accounting for 99.9% of all exposures. Poison centers referred 7.5% to a health care facility. There was no apparent benefit conferred by decontamination therapy. Exposures to unidentified berries represent common inquiries to poison information centers. They are associated with low morbidity and no mortality. If no initial symptoms are present, it is unlikely that the patient will develop clinically relevant effects.

Age Factors↗

PubMed1997

American mistletoe exposures.

American mistletoe is generally considered to be extremely toxic. Although there are no data to support this contention, both the lay public and medical professionals often respond very aggressively after ingestion of any portion of this plant. To determine if American mistletoe is deserving of this reputation, the outcomes of 1,754 exposures to this plant were examined. All mistletoe data extracted from the American Association of Poison Control Centers national data collection system for the period of 1985 to 1992 were analyzed according to patient age, gastrointestinal decontamination therapy, patient outcome, and geographic region of the exposure. Pediatric exposures accounted for 92.1% of the cases, and 94.7% of the reported cases were accidental exposures. Of all cases, 99.2% had an outcome associated with no morbidity, and there were no fatalities. Apparently, patient outcome was not influenced by the use of gastrointestinal decontamination techniques-96.2% of treated patients remained asymptomatic versus 96.3% of patients who received no therapy. The accidental ingestion of American mistletoe is not associated with profound toxicity.

Humans↗

PubMed1997

An evaluation of machine-learning methods for predicting pneumonia mortality.

This paper describes the application of eight statistical and machine-learning methods to derive computer models for predicting mortality of hospital patients with pneumonia from their findings at initial presentation. The eight models were each constructed based on 9847 patient cases and they were each evaluated on 4352 additional cases. The primary evaluation metric was the error in predicted survival as a function of the fraction of patients predicted to survive. This metric is useful in assessing a model's potential to assist a clinician in deciding whether to treat a given patient in the hospital or at home. We examined the error rates of the models when predicting that a given fraction of patients will survive. We examined survival fractions between 0.1 and 0.6. Over this range, each model's predictive error rate was within 1% of the error rate of every other model. When predicting that approximately 30% of the patients will survive, all the models have an error rate of less than 1.5%. The models are distinguished more by the number of variables and parameters that they contain than by their error rates; these differences suggest which models may be the most amenable to future implementation as paper-based guidelines.

Artificial Intelligence↗